Abstract
Objective: Apelin plays a pivotal role in adverse cardiac remodeling and the occurrence of heart failure (HF) with reduced ejection fraction in type 2 diabetes mellitus (T2DM). The purpose of the study was to investigate whether serum levels of apelin predict HF with preserved ejection fraction (HFpEF) in patients with T2DM Design and method: The study was retrospectively involved 76 T2DM individuals aged from 41 to 65 years (48 patients with overt HFpEF and 28 non-HFpEF patients). Healthy control group was consisted of 25 individuals matched with age and sex. Serum levels of N-terminal pro-brain natriuretic peptide (NT-proBNP), apelin, and high sensitive C-reactive protein (hs-CRP) were determined by ELISA Results: Serum levels of apelin and NT-proBNP were significantly increased in patients with HFpEF (7.74 ng/mL, 95% CI = 6.31-8.25 ng/mL and 954.8 pmol/mL, 95% CI = 476.2-1764.3 pmol/mL, respectively) when compared with non-HFpEF diabetics (2.26 ng/mL; 95% CI = 1.70-2.90 ng/mL; and 113.5 pmol/mL, 95% CI = 75.4-144.9 pmol/mL, respectively) and healthy volunteers (1.52 ng/mL 95% CI = 1.12-2.13 ng/mL and 67.8 pmol/mL, 95% CI = 49.1-87.4 pmol/mL; respectively). Apelin levels correlated positively with body mass index (r = 0.32, P = 0.001), serum uric acid (r = 0.30, P = 0.016), HDL cholesterol (r = 0.28, P = 0.001), hs-CRP (r = 0.26, P = 0.001) and were negatively associated with ejection fraction (r = 0.34, P = 0.002), and age (r = -0.30, P = 0.001). The ROC curve showed that the best fitted cut-off point for the apelin to NT-proBNP ratio was 0.82 units (area under curve = 0.76; sensitivity = 69.5%, and specificity 94.2%, P = 0.001). In multivariate logistic regression analysis the apelin to NT-proBNP ratio < 0.82 × 10-2 units independently predicted (odds ratio = 1.44; 95% confidence interval: 1.18 – 2.77; P = 0.001) HFpEF in T2DM patients. Conclusions: Apelin to NT-proBNP ratio < 0.82 × 10-2 was independent predictor for HFpEF in T2DM patients
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