Yagi Kunimasa, Chujo Daisuke, Usui Isao, Liu Jian-Hui, Nohara Atsushi, Shirozu Asako Enkaku, Takikawa Akiko, Honoki Hisae, Fujisaka Shiho, Origasa Hideki, Tada Hayato
Department of Internal Medicine, Kanazawa Medical University Hospital, Kahoku 920-0293, Ishikawa, Japan.
Center for Clinical and Translational Research, Toyama University Hospital, Toyama 930-0152, Toyama, Japan.
World J Diabetes. 2025 Apr 15;16(4):103551. doi: 10.4239/wjd.v16.i4.103551.
Early diagnosis of left ventricular diastolic dysfunction (LVDD) is essential for preventing heart failure. B-type natriuretic peptide (BNP) is a viable marker for predicting LVDD, as elevated BNP levels have been associated with worsening LVDD in patients with diabetes over time. However, the utility of BNP as a diagnostic marker in diabetes is controversial, as BNP levels are often low in overweight individuals.
To examine the effectiveness of BNP levels and fragmented QRS (fQRS) on electrocardiography for diagnosing LVDD in patients with type 2 diabetes.
This retrospective cohort study included 303 patients with type 2 diabetes (67.4 ± 12.3 years old) with preserved ejection fraction (EF) ≥ 50% admitted to Toyama University Hospital for glycemic management and comorbidity evaluation between November 2017 and April 2021. All participants underwent plasma BNP measurement, electrocardiography, and echocardiography. Cardiologists who were blinded to the BNP results assessed the electrocardiograms and echocardiograms. Subgroup analyses were conducted for overweight individuals.
Receiver operating characteristic (ROC) curve analysis determined optimal BNP cut-off values of 34.8 pg/mL and 7.2 pg/mL for diagnosing LVDD in non-overweight [area under the ROC curve (AUC): 0.70] and overweight (AUC: 0.55) groups, respectively ( = 0.040). In the overweight subgroup, fQRS showed greater diagnostic accuracy for LVDD (AUC: 0.67), indicating moderate diagnostic utility compared with the low performance of the BNP cutoff of 35 pg/mL (AUC: 0.52) ( = 0.010). Multivariate analyses confirmed that fQRS was superior to BNP for LVDD diagnosis regardless of the patient's weight.
A BNP level ≥ 35 pg/mL in non-overweight individuals may be a reliable LVDD marker. Additionally, fQRS was more effective than BNP in diagnosing LVDD irrespective of the patient's weight. fQRS can complement BNP in the early detection of LVDD, especially in overweight patients, potentially improving early detection and mitigating progression to heart failure with preserved EF in patients with type 2 diabetes.
左心室舒张功能障碍（LVDD）的早期诊断对于预防心力衰竭至关重要。B型利钠肽（BNP）是预测LVDD的一个可行标志物，因为随着时间的推移，糖尿病患者中BNP水平升高与LVDD恶化相关。然而，BNP作为糖尿病诊断标志物的效用存在争议，因为超重个体的BNP水平通常较低。
探讨BNP水平和心电图碎裂QRS波（fQRS）对2型糖尿病患者LVDD的诊断效果。
这项回顾性队列研究纳入了2017年11月至2021年4月期间因血糖管理和合并症评估入住富山大学医院的303例射血分数（EF）保留≥50%的2型糖尿病患者（67.4±12.3岁）。所有参与者均接受血浆BNP测量、心电图检查和超声心动图检查。对BNP结果不知情的心脏病专家评估心电图和超声心动图。对超重个体进行亚组分析。
受试者工作特征（ROC）曲线分析确定，在非超重[ROC曲线下面积（AUC）：0.70]和超重（AUC：0.55）组中，诊断LVDD的最佳BNP临界值分别为34.8 pg/mL和7.2 pg/mL（P = 0.040）。在超重亚组中，fQRS对LVDD的诊断准确性更高（AUC：0.67），与35 pg/mL的BNP临界值的低效能（AUC：0.52）相比，显示出中等诊断效用（P = 0.010）。多变量分析证实，无论患者体重如何，fQRS在LVDD诊断方面均优于BNP。
非超重个体中BNP水平≥35 pg/mL可能是一个可靠的LVDD标志物。此外，无论患者体重如何，fQRS在诊断LVDD方面比BNP更有效。fQRS可以在LVDD的早期检测中补充BNP，特别是在超重患者中，可能改善早期检测并减轻2型糖尿病患者保留EF的心力衰竭进展。
