Значение N-концевого пропептида натрийуретического гормона B-типа в развитии диастолической дисфункции левого желудочка при сахарном диабете типа 2

Abstract

Introduction. Left ventricular diastolic dysfunction (LV DD) is associated with the development of chronic heart failure (CHF) with preserved ejection fraction. This CHF phenotype is most common in patients with type 2 diabetes mellitus (T2DM). It is relevant to study the relationship between LV DD in patients with T2DM and the level of N-terminal pro-B-type natriuretic peptide (NT-proBNP), as a CHF biomarker, and other clinical, laboratory and echocardiographic parameters. Aim. To determine the significance of NT-proBNP and other factors in the development of LV DD in T2DM in the long-term follow-up period. Materials and methods. The study included 94 patients with T2DM aged 40 to 65 years (65% women). All patients had arterial hypertension (AH), obese or overweight and had no signs of NYHA class III–IV CHF, LV ejection fraction (EF) < 50%. 37 patients had stable coronary artery disease (SCAD). Patients underwent clinical and laboratory examination, echocardiography. The concentration of NT-proBNP was determined. After 8.8 ± 0.72 years, 41 patients with T2DM were examined again with an assessment of clinical, biochemical and echocardiographic parameters. At baseline the 2009 National Guidelines of the Society of Cardiology of the Russian Federation and the Society of Heart Failure Specialists for the diagnosis and treatment of CHF were used for the diagnosis of LV DD. After 8.8 ± 0.72 years, the 2020 Clinical Guidelines of the Russian Society of Cardiology (RSC) for CHF were used for the diagnosis of LV DD. The search for factors that determine the presence of LV DD in the long-term period was carried out using logistic regression and ROC analysis. Results. At baseline LV DD was detected in 81.9% of cases in patients with T2DM and correlated with the presence of SCAD and the duration of AH. T2DM patients with LV DD compared with patients without LV DD did not differ in the level of NT-proBNP (30.6 pg/ml [20; 83.4] vs 36.7 pg/ml [20; 71.1]), p = 0.7). After 8.8 ± 0.72 years, LV DD was detected in 51.2% of patients with T2DM according to the 2020 Clinical Guidelines of the RSC. Patients with T2DM were divided into 2 groups: with LV DD (group 1) and without LV DD (group 2). Patients of the first and second groups differed in duration of diabetes (20 years [16; 25] vs 17.5 years [14.5; 20.5], р = 0.04), body mass index (BMI) (33.9 kg/m2 [31.2; 37.4] vs 32.2 kg/m2 [27.4; 34.7], р = 0.03), left ventricular mass index (LVMI) (94.8 g/m2 [82.5; 107] vs 73.9 g/m2 [71; 82.7], p < 0.01) and were comparable in terms of carbohydrate, lipid metabolism, and kidney function. Compared to the second group, the first group had the higher baseline level of NT-proBNP (47.3 pg/ml [23.4; 111] vs 20 pg/ml [20; 20.3], p < 0.01), higher baseline BMI (34.6 kg/m2 [30; 38] vs 31.2 kg/m2 [29.6; 33.7], р = 0.04) and higher baseline LVMI (101.1 ± 1 g/m2 vs 86.3 ± 14.1 g/m2, р = 0.02). The logistic regression revealed that in patients with T2DM the presence of LV DD in the long-term period is associated with the level of NT-proBNP (p = 0.03), baseline BMI (p = 0.04), baseline LVMI (p = 0.01). The baseline level of NT-proBNP > 31.2 pg/ml showed a sensitivity of 66.7% and a specificity of 100% for the presence of LV DD in patients with T2DM after 8.8 ± 0.72 years of follow-up. Conclusion. In the long-term follow-up period the presence of LV DD in patients with type 2 diabetes mellitus is associated with the increased baseline level of NT-proBNP, especially in combination with the increased baseline LVMI and BMI values, while the level of NT-proBNP > 31.2 pg/ml can be considered as a prognostic marker of LV DD in patients with T2DM after 8.8 ± 0.72 years of follow-up with a sensitivity of 66.7% and a specificity of 100%.