Joshi Ameya, Dalal Dhaval, Patil Sandeep, Singh Harminder, Hajirnis Apoorva, Seth Chandani, Pakhare Abhijit P, Abdagire Nitinkumar, Khatu Priti
Endocrinology, Bhaktivedanta Hospital and Research Institute, Thane, IND.
Internal Medicine, Bhaktivedanta Hospital and Research Institute, Thane, IND.
Cureus. 2024 Oct 28;16(10):e72576. doi: 10.7759/cureus.72576. eCollection 2024 Oct.
Objective Heart failure (HF) is an important underrecognized complication of type 2 diabetes mellitus (T2DM). Recent literature and recommendations support screening for HF among T2DM people attending the outpatient department (OPD) in non-emergency settings using a biomarker. The present study is a retrospective cross-sectional study that assesses the prevalence of screen positivity (S+) for undiagnosed HF among T2DM people (with normal electrocardiogram (ECG) and no history of heart disease) attending the OPD at a tertiary care center in India using N-terminal pro-B-type natriuretic peptide (NT-proBNP). It also highlights the risk factors for S+ for HF. Methods This is a retrospective cross-sectional study of the practice of NT-proBNP screening in T2DM to diagnose stage B HF. A total of 1,049 consecutive people with T2DM (age range: 18-75 years) attending the OPD of a tertiary care institute in India were screened for HF using NT-proBNP (cut off S+ >125 pg/mL). Demographic variables, vitals, smoking status, family history, status of hypertension, medications for diabetes, and glycemic control were recorded and correlated with the risk of S+ for HF. Results Of the 1,049 people with T2DM, 336 (32.03%) had S+ for HF. Those with S+ had higher age (62.5+9.3 vs 54.2 +10.6 years), longer duration of T2DM (14.4 +7.8 vs 9.6 +6.1 years), positive history for smoking (94 [28%] vs 55 [7.7%]) and tobacco chewing (66 [19.6%] vs 24 [3.4%]), higher blood pressures (both systolic [152.1+19.9 vs 134.6 +15 mmHg] and diastolic [87.7+9.6 vs 83.9+7.8 mmHg]), higher glycated hemoglobin (HbA1c) (8.4+1.4 vs 7.6+1 years), higher BMI (28.3+2.8 vs 27.2+2.1 kg/m), presence of chronic kidney disease (CKD) (210 [62.5 %] vs 118 [16.5%]), and a positive family history of cardiac ailments (185 [55.1%] vs 122 [17.1%]) (<0.05 for all). The above factors also correlated with increased chances of S+ for HF on regression analysis. Conclusion S+ for HF is common in people with T2DM attending OPDs. The S+ was associated with increasing age, longer duration of T2DM, smoking and tobacco chewing, uncontrolled hypertension and T2DM, obesity, the presence of CKD, use of pioglitazone and insulin, and positive family history. It is the need of the hour to widely extend routine screening for HF in T2DM patients using NT-proBNP in the OPD setting so that benefits of guideline-based therapy can be extended.
目的 心力衰竭（HF）是2型糖尿病（T2DM）一种重要但未得到充分认识的并发症。近期文献及建议支持在非紧急情况下，对门诊（OPD）就诊的T2DM患者使用生物标志物筛查HF。本研究是一项回顾性横断面研究，评估在印度一家三级医疗中心门诊就诊的T2DM患者（心电图（ECG）正常且无心脏病史）中，未诊断HF的筛查阳性（S+）患病率，采用N末端B型利钠肽原（NT-proBNP）进行评估。同时本研究还强调了HF筛查阳性的危险因素。方法 这是一项关于NT-proBNP筛查T2DM以诊断B期HF的回顾性横断面研究。对印度一家三级医疗机构门诊连续就诊的1049例T2DM患者（年龄范围：18 - 75岁）使用NT-proBNP（筛查阳性标准S+>125 pg/mL）进行HF筛查。记录人口统计学变量、生命体征、吸烟状况、家族史、高血压状况、糖尿病用药情况及血糖控制情况，并与HF筛查阳性风险进行相关性分析。结果 在1049例T2DM患者中，336例（32.03%）HF筛查阳性。筛查阳性者年龄更大（62.5±9.3岁 vs 54.2±10.6岁），T2DM病程更长（14.4±7.8年 vs 9.6±6.1年），吸烟史阳性（94例[28%] vs 55例[7.7%]）及嚼烟史阳性（66例[19.6%] vs 24例[3.4%]），血压更高（收缩压[152.1±19.9 mmHg vs 134.6±15 mmHg]及舒张压[87.7±9.6 mmHg vs 83.9±7.8 mmHg]），糖化血红蛋白（HbA1c）更高（8.4±1.4 vs 7.6±1），体重指数（BMI）更高（28.3±2.8 vs 27.2±2.1 kg/m²），存在慢性肾脏病（CKD）（210例[62.5%] vs 118例[16.5%]），以及心脏疾病家族史阳性（185例[55.1%] vs 122例[17.1%]）（所有比较P<0.05）。上述因素在回归分析中也与HF筛查阳性几率增加相关。结论 在门诊就诊的T2DM患者中，HF筛查阳性很常见。筛查阳性与年龄增长、T2DM病程延长、吸烟和嚼烟、高血压及T2DM控制不佳、肥胖、CKD存在、使用吡格列酮和胰岛素以及家族史阳性有关。当下迫切需要在门诊环境中广泛推广使用NT-proBNP对T2DM患者进行HF常规筛查，以便能扩大基于指南治疗的益处。
