Ramaprabha S S, Alexander Hariharan, Latha Josephine, Mohanty Pradipta Kumar
Department of Biochemistry, Velammal Medical College Hospital and Research Institute, Madurai, Tamil Nadu, India.
EJIFCC. 2025 Jun 3;36(2):165-170. eCollection 2025 Jun.
Despite advancements in medical care, including coronary interventions and medications, cardiovascular-related mortality and morbidity remain disproportionately high among patients with diabetes mellitus. A significant factor contributing to this issue is the presence of asymptomatic macrovascular and microvascular angiopathies in many diabetic patients. These vascular complications are often detected at later stages, resulting in the failure of treatment strategies to effectively prevent the progression of heart failure and mitigate worsening conditions. Given this background, our research aims to explore the potential of the biochemical marker NT-pro-BNP (N-terminal pro b-type natriuretic peptide) in the early detection of left ventricular diastolic dysfunction in diabetic patients who maintain a preserved ejection fraction. Left ventricular diastolic dysfunction is a condition where the left ventricle has difficulty relaxing and filling with blood, which can precede the development of heart failure. Identifying this dysfunction early could be crucial in preventing major adverse cardiac events (MACE) such as heart attacks, stroke, and cardiovascular-related death. The focus of our study is to determine whether NT-pro-BNP, which is typically elevated in heart failure, can serve as an early marker for diastolic dysfunction in this specific patient population. By identifying diabetic patients at risk earlier, interventions could be tailored more effectively, potentially improving outcomes and reducing the incidence of severe cardiovascular events.
This study was conducted at a tertiary care medical care hospital in Madurai, Tamil Nadu, India, with a sample population of 500 patients who had preserved ejection fraction. The participants were divided into two groups: 169 diabetic patients and 150 non-diabetic patients. As part of the baseline assessment, routine clinical chemistry analysis and 2D echocardiograms were performed. Additionally, the biomarker NT-pro-BNP, which is associated with heart failure, was measured using the electrochemiluminescence method.
Among the diabetes and non-diabetes groups, the biomarker NT-pro-BNP were significantly different and the serum concentration of NT-pro-BNP was found to be higher in poor glycemic control type 2 diabetes mellitus patients. Serum NT-pro-BNP screening and 2D echocardiogram showed the best predictor of left ventricular diastolic dysfunction and hospital stay due to major adverse cardiac events in type 2 diabetes mellitus patients.
Our study highlights the clinical significance of NT-pro-BNP among (left ventricular diastolic dysfunction) type 2 diabetes mellitus with preserved ejection fraction > 60 %.
尽管在医疗护理方面取得了进步，包括冠状动脉介入治疗和药物治疗，但糖尿病患者中心血管相关的死亡率和发病率仍然过高。导致这一问题的一个重要因素是许多糖尿病患者存在无症状的大血管和微血管病变。这些血管并发症往往在后期才被发现，导致治疗策略无法有效预防心力衰竭的进展和缓解病情恶化。在此背景下，我们的研究旨在探索生化标志物NT-pro-BNP（N末端B型利钠肽原）在早期检测射血分数保留的糖尿病患者左心室舒张功能障碍方面的潜力。左心室舒张功能障碍是指左心室难以舒张和充血的一种状况，可能先于心力衰竭的发生。早期识别这种功能障碍对于预防重大不良心脏事件（MACE），如心脏病发作、中风和心血管相关死亡可能至关重要。我们研究的重点是确定通常在心力衰竭中升高的NT-pro-BNP是否可以作为这一特定患者群体舒张功能障碍的早期标志物。通过更早地识别有风险的糖尿病患者，可以更有效地调整干预措施，有可能改善治疗结果并降低严重心血管事件的发生率。
本研究在印度泰米尔纳德邦马杜赖的一家三级医疗医院进行，样本为500名射血分数保留的患者。参与者分为两组：169名糖尿病患者和150名非糖尿病患者。作为基线评估的一部分，进行了常规临床化学分析和二维超声心动图检查。此外，使用电化学发光法测量了与心力衰竭相关的生物标志物NT-pro-BNP。
在糖尿病组和非糖尿病组中，生物标志物NT-pro-BNP存在显著差异，且血糖控制不佳的2型糖尿病患者的NT-pro-BNP血清浓度更高。血清NT-pro-BNP筛查和二维超声心动图显示，它们是2型糖尿病患者左心室舒张功能障碍和因重大不良心脏事件住院时间的最佳预测指标。
我们的研究强调了NT-pro-BNP在射血分数保留>60%的2型糖尿病（左心室舒张功能障碍）患者中的临床意义。
