Cardiology Division, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong.
Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong, Hong Kong.
Postgrad Med J. 2023 Jun 8;99(1171):476-483. doi: 10.1136/postgradmedj-2022-141548.
BACKGROUND: International guidelines recommend natriuretic peptide biomarker-based screening for patients at high heart failure (HF) risk to allow early detection. There have been few reports about the incorporation of screening procedure to existing clinical practice. OBJECTIVE: To implement screening of left ventricular dysfunction in patients with type 2 diabetes mellitus (DM). METHOD: A prospective screening study at the DM complication screening centre was performed. RESULTS: Between 2018 and 2019, 1043 patients (age: 63.7±12.4 years; male: 56.3%) with mean glycated haemoglobin of 7.25%±1.34% were recruited. 81.8% patients had concomitant hypertension, 31.1% had coronary artery disease, 8.0% had previous stroke, 5.5% had peripheral artery disease and 30.7% had chronic kidney disease (CKD) stages 3-5. 43 patients (4.1%) had an elevated N-terminal prohormone of brain natriuretic peptide (NT-proBNP) concentration above the age-specific diagnostic thresholds for HF, and 43 patients (4.1%) had newly detected atrial fibrillation (AF). The prevalence of elevated NT-proBNP increased with age from 0.85% in patients aged <50 years to 7.14% in those aged 70-79 years and worsening kidney function from 0.43% in patients with CKD stage 1 to 42.86% in CKD stage 5. In multivariate logistic regression, male gender (OR: 3.67 (1.47-9.16), p = 0.005*), prior stroke (OR: 3.26 (1.38-7.69), p = 0.007*), CKD (p<0.001*) and newly detected AF (OR: 7.02 (2.65-18.57), p<0.001*) were significantly associated with elevated NT-proBNP. Among patients with elevated NT-proBNP, their mean left ventricular ejection fraction (LVEF) was 51.4%±14.7%, and 45% patients had an LVEF <50%. CONCLUSION: NT-proBNP and ECG screening could be implemented with relative ease to facilitate early detection of cardiovascular complication and improve long-term outcomes.
背景:国际指南建议对心力衰竭(HF)高危患者进行利钠肽生物标志物筛查,以实现早期发现。但是,关于将筛查程序纳入现有临床实践的报道很少。
目的:在 2 型糖尿病(DM)患者中实施左心室功能障碍的筛查。
方法:在 DM 并发症筛查中心进行了一项前瞻性筛查研究。
结果:2018 年至 2019 年间,共招募了 1043 名年龄为 63.7±12.4 岁的患者(男性占 56.3%),平均糖化血红蛋白为 7.25%±1.34%。81.8%的患者合并高血压,31.1%的患者患有冠心病,8.0%的患者患有既往卒中,5.5%的患者患有外周动脉疾病,30.7%的患者患有慢性肾脏病(CKD)3-5 期。43 名(4.1%)患者的 N 端脑利钠肽前体(NT-proBNP)浓度升高,超过了 HF 的年龄特异性诊断阈值,43 名(4.1%)患者新发心房颤动(AF)。随着年龄的增长,NT-proBNP 浓度升高的患病率从<50 岁患者的 0.85%增加到 70-79 岁患者的 7.14%,从 CKD 1 期患者的 0.43%增加到 CKD 5 期患者的 42.86%。在多变量逻辑回归中,男性(比值比[OR]:3.67[1.47-9.16],p=0.005*)、既往卒中(OR:3.26[1.38-7.69],p=0.007*)、CKD(p<0.001*)和新发 AF(OR:7.02[2.65-18.57],p<0.001*)与 NT-proBNP 升高显著相关。在 NT-proBNP 升高的患者中,平均左心室射血分数(LVEF)为 51.4%±14.7%,45%的患者 LVEF<50%。
结论:通过相对简单的 NT-proBNP 和心电图筛查,可以实现早期发现心血管并发症,并改善长期预后。
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