Natriuretic Peptide System Activation in Acute Heart Failure Patients with Diabetes.

Filipe M Cunha,Paulo Bettencourt,Joana Pereira,Maria João Pinto,Helena Moreira,Patrícia Lourenço,Pedro Marques,Pedro Rodrigues

doi:10.1155/2017/1426705

Abstract

Background Elevated B-type natriuretic peptide (BNP) is a hallmark in heart failure (HF). Diabetic patients with chronic HF seem to have higher BNP than nondiabetics. We studied, in acute HF, if BNP levels are different between diabetics and nondiabetics. Methods From a prospectively recruited population of acute HF patients, we selected a convenience sample. In pair-matched analysis, each diabetic patient was matched with a nondiabetic of the same age (±1 year), gender, and according to left ventricular systolic dysfunction. Diabetics and nondiabetics were compared. Cox-regression analysis was used to analyse the prognostic impact of diabetes. Results We studied 328 patients, mean age: 78 years, 44.5% male. Diabetics were more often hypertensive and had ischemic HF; they had higher body mass index, lower haemoglobin, and worse renal function. Diabetics were more often discharged on ACE inhibitors/ARB, antiplatelet therapy, and statins. Neither admission nor discharge BNP values differed between diabetics and pair-matched nondiabetics. One-year mortality was also nondifferent between pairs of diabetics and nondiabetics: 44 (26.8%) and 46 (28.0%), respectively. HR for 1-year mortality in diabetics was 1.00 (95% CI: 0.82–1.24) compared with nondiabetics. Conclusions HF patients with diabetes have similar neurohumoral activation when compared with nondiabetics. One-year mortality is also nondifferent after matching for age, gender, and systolic function.

Highlights

Diabetes is a known risk factor for incident heart failure (HF) [1, 2] and has been reported to associate with worse outcome in patients with established HF [3,4,5,6,7].B-type natriuretic peptide (BNP) is produced by the stressed heart, namely, the stressed ventricles, and is a mostly friendly counter-regulatory peptide [8]
We aimed to study if the neurohumoral activation is different between diabetic and nondiabetic acute HF patients matched for age, gender, and left ventricular systolic dysfunction
From a total of 657 patients hospital admitted with the primary diagnosis of acute HF, 267 (40.6%) had a known diagnosis of type 2 diabetes mellitus and a new diagnosis of type 2 diabetes was made in 63 patients (9.6%)

Summary

Introduction

Diabetes is a known risk factor for incident heart failure (HF) [1, 2] and has been reported to associate with worse outcome in patients with established HF [3,4,5,6,7].B-type natriuretic peptide (BNP) is produced by the stressed heart, namely, the stressed ventricles, and is a mostly friendly counter-regulatory peptide [8]. BNP levels are higher in HF patients with systolic dysfunction when compared to those of patients with HF with preserved ejection fraction [16, 17]. Older age, and worse renal function are associated with higher BNP levels [18, 19]. BNP levels are lower in patients with higher body mass index (BMI) [20]. Diabetic patients with chronic HF seem to have higher BNP than nondiabetics. In acute HF, if BNP levels are different between diabetics and nondiabetics. In pair-matched analysis, each diabetic patient was matched with a nondiabetic of the same age (±1 year), gender, and according to left ventricular systolic dysfunction. One-year mortality is nondifferent after matching for age, gender, and systolic function

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