Influence of diabetes on natriuretic peptide thresholds in screening for Stage B heart failure

Abstract

Context: Natriuretic peptide (NP) has been shown to be an effective screening tool to identify patients with Stage B heart failure and to have clinical value in preventing heart failure progression. The impact of associated metabolic confounders on the screening utility of NP needs clarification.

Objective: To assess the impact of diabetes mellitus (DM) on NP screening for asymptomatic Stage B heart failure.

Materials and methods: The study population consisted of 1368 asymptomatic patients with cardiovascular risk factors recruited from general practice as part of the STOP-HF trial. B-type NP (BNP) was quantified at point-of-care.

Results: BNP was found to be as accurate for detecting Stage B heart failure in DM patients compared to non-DM patients (AUC 0.75 [0.71,0.78] and 0.77 [0.72,0.82], respectively). However, different BNP thresholds are required to achieve the same level of diagnostic sensitivity in DM compared with non-DM patients. To achieve 80% sensitivity a difference of 5-ng/L lower is required for patients with DM.

Conclusion: Although a significantly different BNP threshold is detected for patients with DM, the BNP concentration difference is small and unlikely to warrant a clinically different diagnostic threshold.

Keywords:

• B-type natriuretic peptide
• cardiac biomarker
• cardiovascular disease
• diabetes mellitus
• ventricular dysfunction

Disclosure statement

None declared.

Funding information

This work was supported by the Health Research Board of Ireland and the European Commission FP7 project FIBRO-TARGETS [grant numbers CSA-2012-36; 602904, respectively].