Background: Diagnostic tests including echocardiography, albuminuria, electrocardiogram (ECG), high-sensitivity troponin I (hs-TnI), and N-terminal prohormone brain natriuretic peptide (NT-proBNP) have been suggested as cardiovascular (CV) risk predictors in type 2 diabetes. We studied the separate and combined prognostic yield of these risk markers.
Methods: In all, 1030 patients with type 2 diabetes were recruited from specialized clinics in this prospective cohort study. Full echocardiographic evaluation was feasible in 886 patients in sinus rhythm with adequate image quality. ECG was performed in 998 patients. Albuminuria was measured in 1009 and NT-proBNP/hs-TnI in 933 patients. The end point was a composite of CV events.
Results: The median follow-up was 4.7 years (interquartile range: 4.0-5.3), and 174 patients experienced a CV disease event. All considered markers, except hs-TnI, were significantly (P < .001) associated with the outcome: abnormal echocardiogram (hazard ratio 2.40 [1.70-3.39]), albuminuria 2.01 (1.47-2.76), abnormal ECG (2.27 [1.66-3.08]), high NT-proBNP (>150 pg/mL) 3.05 (2.11-4.40), and hs-TnI 1.12 (0.79-1.59). After adjusting for clinical variables, all remained significantly associated with the end point. However, after adjusting for each other, only NT-proBNP >150 pg/mL remained significantly associated with the end point (2.07 [1.28-3.34], P < .001). Measured by C-statistics, model performance was highest with log2 (NT-proBNP) (0.70 [0.65-0.75]) and similar to clinical variables alone (0.71 [0.67-0.76]). Combining all risk markers only resulted in a very limited increase in C-statistics (0.69 [0.64-0.74]).
Conclusions: This study identified NT-proBNP over echocardiography, ECG, and albuminuria in risk prediction in patients with type 2 diabetes. The diagnostic yield in considering more than one risk marker was limited in this population.
背景: 超声心动图、蛋白尿、心电图(ECG)、高敏肌钙蛋白I(hs-TnI)和N末端前激素脑钠素(NT-proBNP)等诊断试验被认为能够预测2型糖尿病心血管(CV)的危险因素。我们研究了这些风险标记物的单独和联合预测效果。 方法: 在这项前瞻性队列研究中, 从专科诊所共招募1030名2型糖尿病患者。886例窦性心律且图像质量良好的患者进行了超声心动图的全面评估。对998例患者进行心电图检查。1009例患者检测蛋白尿, 933例患者检测NT-proBNP/hs-TnI。终点是CV事件的组合。 结果: 中位随访时间为4.7年(四分位数范围:4.0-5.3), 174名患者经历了心血管疾病事件。除hs-TnI外, 所有考虑的标志物:超声心动图异常(危险比2.40[1.70-3.39])、蛋白尿2.01(1.47-2.76)、心电图异常(2.27[1.66-3.08])、高NT-proBNP(>150pg/mL)3.05(2.11-4.40)和hs-TnI 1.12(0.79-1.59) 均与预后显著相关(P<0.001)。在调整了临床变量后, 所有这些变量仍然与终点显著相关。然而, 在变量间调整后, 只有NT-proBNP>150pg/mL与终点显著相关(2.07[1.28-3.34], P<0.001)。通过C-统计量测量, log2 (NT-proBNP)的模型性能最高(0.70[0.65-0.75]), 与单独使用临床变量(0.71[0.67-0.76])相似。合并所有风险标记物只会导致非常有限的C-统计量增加(0.69[0.64-0.74])。 结论: 本研究证实NT-proBNP在预测2型糖尿病患者风险方面优于超声心动图、心电图和蛋白尿。在这一人群中, 考虑多个风险标记物的诊断效果是有限的。.
Keywords: 2型糖尿病; albuminuria; echocardiography; electrocardiography; plasma NT-proBNP; type 2 diabetes; 心电图; 蛋白尿; 血浆NT-proBNP; 超声心动图.
© 2021 Ruijin Hospital, Shanghai JiaoTong University School of Medicine and John Wiley & Sons Australia, Ltd.