Screening for left ventricular hypertrophy in patients with type 2 diabetes mellitus in the community
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Key result
NT-proBNP demonstrated an area under the curve of 0.68 for detecting left ventricular hypertrophy, proving superior to 12-lead ECG but remaining inadequate for routine screening in asymptomatic type 2 diabetes.
Why the study?
Does NT-proBNP or 12-lead ECG accurately detect left ventricular hypertrophy in asymptomatic patients with type 2 diabetes?
Population
294 asymptomatic patients with type 2 diabetes diagnosed for >5 years and/or on treatment, recruited from…
Comparison
NT-proBNP measurement and 12-lead… vs Transthoracic echocardiography
Design
Cross-sectional, The echocardiographer and cardiologist measuring the images…
Authors
Discussion
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Implication
NT-proBNP and ECG should not yet guide LVH screening in asymptomatic T2D; leaves open need for more accurate noninvasive tools.
Study Design
Type
Cross-Sectional (n=294)
Blinding
Single-blind
Multicenter
Yes
Structured PICO
Does NT-proBNP or 12-lead ECG accurately detect left ventricular hypertrophy in asymptomatic patients with type 2 diabetes?
P
Population
294 asymptomatic patients with type 2 diabetes, free of known cardiovascular disease, evaluated cross-sectionally for left ventricular hypertrophy.
E
Exposure
NT-proBNP measurement (Roche Diagnostics Elecsys assay) and 12-lead electrocardiography (ECG) using Sokolow-Lyon or Cornell voltage criteria
C
Comparator
Transthoracic echocardiography (reference standard for left ventricular hypertrophy)
O
Outcome
Diagnostic accuracy (Area Under the Curve, sensitivity, specificity) of NT-proBNP and ECG for the detection of left ventricular hypertrophysurrogate
Main Result
Effect estimate: AUC 0.68 (95% CI 0.62-0.74)
In asymptomatic patients with type 2 diabetes, left ventricular hypertrophy is highly prevalent, but neither standard 12-lead ECG nor NT-proBNP are adequately sensitive screening tools for its detection.
Limitations
- Silent myocardial ischaemia was not systematically assessed.
- Approximately half of the cohort had an NT-proBNP measurement below the functional sensitivity of the assay.
- Potential over-estimation of LVH by echocardiography, though deemed unlikely.
- Functional sensitivity of the NT-proBNP assay may have decreased performance at low concentrations
- Silent myocardial ischaemia was not assessed or excluded
- Possible over-estimation of LVH by echocardiography
Cite This Study
Somaratne et al. (2011) conducted a cross-sectional in Type 2 diabetes mellitus (n=294). NT-proBNP vs. 12-lead ECG was evaluated on Detection of left ventricular hypertrophy (AUC) (AUC 0.68, 95% CI 0.62-0.74). NT-proBNP demonstrated an area under the curve of 0.68 for detecting left ventricular hypertrophy, proving superior to 12-lead ECG but remaining inadequate for routine screening in asymptomatic type 2 diabetes.
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