P3427Prognostic performance of echocardiography, electrocardiogram, albuminuria, plasma proBNP and hs-TnI in patients with type 2 diabetes

Abstract

Abstract Background A range of diagnostic tests including echocardiography, albuminuria, electrocardiogram (ECG), plasma measurement of high sensitivity troponin T (hs-TnI) and pro-brain natriuretic peptide (proBNP) have been suggested as cardiovascular (CV) risk predictors in patients with type 2 diabetes. In this study we examined prognostic yield from these risk markers. Methods A total of 1,030 out-patients followed at a large secondary care diabetes clinic were recruited. Echocardiography was considered feasible in patients in sinus rhythm with adequate image quality (n=886). Abnormal echocardiography was defined as a left ventricular ejection fraction (LVEF) <50%; a ratio of early diastolic mitral inflow velocity to early diastolic septal annular velocity (E/e'septal) ≥15; increased left ventricular mass index (>95 g/m2 for women and >115 g/m2 for men) or left atrial volume index >34 ml/m2. ECG was performed in 983 patients and was considered abnormal in the presence of abnormal Q-waves; ST-T segment deviation or bundle branch block. We measured urine albumin (n=1,009) and proBNP/hs-TnI (n=933). The end-point of CV event was a composite of CV death and hospitalization with myocardial infarction/revascularization, stroke, peripheral artery disease or heart failure. Results The median follow-up was 4.7 years (interquartile range: 4.0 to 5.3) and 174 patients suffered an CVD event. All markers except hs-TnI were significantly (p<0.001) associated with the composite outcome: Abnormal echocardiogram: Hazard ratio (95% confidence interval): 2.39 (1.69–3.37); albuminuria 2.01 (1.47–2.76); abnormal ECG 2.35 (1.72–3.21); log2(proBNP) 1.60 (1.47–1.75) and hs-TnI 1.05 (0.92–1.19). The findings persisted after adjusting for clinical variables, but after adjusting for the other markers, only log2(proBNP) remained associated with the composite outcome (1.50 (0.20–1.73), p<0.001), figure. Measured by C-index model performance was highest with proBNP (0.70 (0.65–0.75)) and similar to clinical variables (0.71 (0.67–0.76)). Combining risk markers only resulted in very limited increase in C-index (echocardiogram, albuminuria, ECG and proBNP: 0.71 (0.66–0.76)). Uni- and multivariables Conclusions This study identifies proBNP measurement in plasma over echocardiography, ECG and albuminuria for risk prediction in patients with type 2 diabetes. The diagnostic yield in considering more than one risk marker was limited in this population.