Why the study?
The importance of routine assessment of myocardial function using NT-proBNP and echocardiographic diastolic function in type 1 diabetes patients with preserved LVEF and no known heart disease is not known.
Does the assessment of NT-proBNP and E/e' predict major cardiovascular events and mortality in patients with type 1 diabetes without known heart disease?
Cohort (n=960)
Does the assessment of NT-proBNP and E/e' predict major cardiovascular events and mortality in patients with type 1 diabetes without known heart disease?
In patients with type 1 diabetes without known heart disease, combining NT-proBNP and echocardiographic E/e' significantly improves cardiovascular risk prediction.
Answers are grounded in this paper and cite their sources.
NT-proBNP and E/e' identify higher-risk type 1 diabetes patients with preserved LVEF; leaves open whether routine assessment improves outcomes or should change practice.
AIMS: Patients with type 1 diabetes have a high risk of cardiovascular disease. Yet, the importance of routine assessment of myocardial function in patients with type 1 diabetes is not known. Thus, we examined the prognostic importance of NT-proBNP and E/e', an echocardiographic measure of diastolic function, in type 1 diabetes patients with preserved left ventricular ejection fraction (LVEF) and without known heart disease. METHODS AND RESULTS: Type 1 diabetes patients without known heart disease and LVEF ≥45% enrolled in the Thousand and 1 study were included and followed through nationwide registries. The risk of major cardiovascular events (MACE) and death associated with levels of NT-proBNP and E/e' was examined. Of 960 patients, median follow-up of 6.3 years (Q1-Q3: 5.7-7.0), 121 (12%) experienced MACE and 51 (5%) died. Increased levels of both NT-proBNP and E/e' were associated with worse outcomes (adjusted hazard ratios for MACE = 1.56 (1.23-1.98) and 4.29 (2.25-8.16) per Loge increase for NT-proBNP and E/e', respectively). NT-proBNP and E/e' combined significantly improved the discrimination power of the Steno T1D risk engine (MACE, C-index: 0.813 (0.779-0.847) vs 0.779 (0.742-0.816); P = 0.0001; All-cause mortality, C-index 0.855 (0.806-0.903) vs 0.828 (0.776-0.880); P = 0.03). CONCLUSION: In patients with type 1 diabetes, preserved ejection fraction, and no known heart disease, NT-proBNP and E/e' were associated with increased risk of MACE and all-cause mortality. The risks associated with NT-proBNP and E/e' combined identified patients at remarkably high risk.
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Rørth et al. (2020) conducted a cohort in Type 1 diabetes with preserved LVEF and without known heart disease (n=960). NT-proBNP and E/e' was evaluated on Major cardiovascular events (MACE) (HR 1.56, 95% CI 1.23-1.98).
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