Cardiovascular prognostic value of echocardiography and N terminal pro B-type natriuretic peptide in type 1 diabetes: the Thousand & 1 Study.

Abstract

AIMS:

Patients with type 1 diabetes have a high risk of cardiovascular disease. Yet, the importance of routine assessment of myocardial function in patients with type 1 diabetes is not known. Thus, we examined the prognostic importance of NT-proBNP and E/e', an echocardiographic measure of diastolic function, in type 1 diabetes patients with preserved left ventricular ejection fraction (LVEF) and without known heart disease.

METHODS AND RESULTS:

Type 1 diabetes patients without known heart disease and LVEF ≥45% enrolled in the Thousand and 1 study were included and followed through nationwide registries. The risk of major cardiovascular events (MACE) and death associated with levels of NT-proBNP and E/e' was examined. Of 960 patients, median follow-up of 6.3 years (Q1-Q3: 5.7-7.0), 121 (12%) experienced MACE and 51 (5%) died. Increased levels of both NT-proBNP and E/e' were associated with worse outcomes (adjusted hazard ratios for MACE = 1.56 (1.23-1.98) and 4.29 (2.25-8.16) per Loge increase for NT-proBNP and E/e', respectively). NT-proBNP and E/e' combined significantly improved the discrimination power of the Steno T1D risk engine (MACE, C-index: 0.813 (0.779-0.847) vs 0.779 (0.742-0.816); P = 0.0001; All-cause mortality, C-index 0.855 (0.806-0.903) vs 0.828 (0.776-0.880); P = 0.03).

CONCLUSION:

In patients with type 1 diabetes, preserved ejection fraction, and no known heart disease, NT-proBNP and E/e' were associated with increased risk of MACE and all-cause mortality. The risks associated with NT-proBNP and E/e' combined identified patients at remarkably high risk.

• Authors: Rasmus Rørth, Peter Godsk Jørgensen, Henrik Ullits Andersen, Christina Christoffersen, Jens Peter Gøtze, Lars Køber, Peter Rossing, Magnus Thorsten Jensen
• Journal: European journal of endocrinology (Eur J Endocrinol) Vol. 182 Issue 5 Pg. 481-488 (May 2020) ISSN: 1479-683X [Electronic] England
• PMID: 32209724 (Publication Type: Journal Article)

Chemical References

• Peptide Fragments
• pro-brain natriuretic peptide (1-76)
• Natriuretic Peptide, Brain

Topics

• Adult
• Aged
• Cardiovascular Diseases (blood, diagnostic imaging)
• Cohort Studies
• Cross-Sectional Studies
• Diabetes Mellitus, Type 1 (blood, diagnostic imaging)
• Echocardiography (methods)
• Female
• Humans
• Longitudinal Studies
• Male
• Middle Aged
• Natriuretic Peptide, Brain (blood)
• Peptide Fragments (blood)
• Prognosis
• Stroke Volume (physiology)
• Ventricular Function, Left (physiology)