Zaporožskij Medicinskij Žurnal (Oct 2020)
The diagnostic value of brain natriuretic peptide in men with comorbid essential arterial hypertension and type 2 diabetes mellitus
Abstract
The aim of the work is to investigate the diagnostic informativeness of brain natriuretic peptide (BNP) in men with left ventricular (LV) diastolic dysfunction (DD) and initial stages of chronic heart failure (CHF) in comorbid stage 2 essential hypertension (EH 2) and type 2 diabetes mellitus (T2DM). Materials and methods. We examined 211 men. 79 people without signs of cardiovascular disease were assigned to a control group. 62 patients with EH 2 and CHF no higher than NYHA functional class (FC) I were included in the 1st, and 70 men with EH 2 combined with T2DM and CHF FC I–II formed the 2nd main study group. The plasma concentration of BNP was measured by ELISA. The examination included the determination of HbA1c, blood lipid profile, echocardiography. The mathematical processing was performed using the standard statistical package Statistica 6.1. Results. Plasma levels of BNP in comorbid EH 2 and T2DM were significantly higher (102.18 ± 4.18 pg/ml) than those in patients with EH without T2DM (77.40 ± 2.85 pg/ml) and in subjects without cardiovascular diseases (21.74 ± 0.59 pg/ml) (P < 0.00001). According to the regression analysis, the level of BNP was associated with changes in parameters of intracardiac hemodynamics in patients with EH2. In patients with comorbid EH 2 and T2DM, the level of BNP was also associated with indicators of systemic hemodynamics and body weight. BNP as a marker of CHF at the recommended borderline level (35 pg/ml) in patients with EH 2 and T2DM was characterized by a sensitivity of 98.57 % and specificity of 55.32 %. The BNP borderline levels with higher specificity were determined for early diagnosis of CHF in EH 2 with T2DM and obesity comorbidities. Conclusions. BNP, as an early marker of LV DD and the initial stages of CHF at the recommended borderline level in men with comorbid EH 2 and T2DM does not have sufficiently high specificity. In these pathological conditions, the determined borderline levels of BNP can be used as indicative surrogate markers for early diagnosis of CHF during screening with the view to identify persons for further echocardiographic additional examination and in cases where echocardiography is not possible.
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