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Opportunistic screening for asymptomatic left ventricular dysfunction in type 2 diabetes mellitus
  1. Mi Zhou1,
  2. Duo Huang1,
  3. Yangyang Cheng1,
  4. Yee Man Lau1,
  5. Wing Hon Lai1,
  6. Yuk-Ming Lau1,
  7. JoJo Hai1,
  8. Chu Pak Lau1,
  9. Esther W Chan2,
  10. Wen Sheng Yue3,
  11. Ming-Liang Zuo4,
  12. Li Xue Yin4,
  13. Yingqing Feng5,
  14. Ning Tan5,
  15. Jiyan Chen5,
  16. Xin Li Li6,
  17. Hung Fat Tse1,
  18. Chi Ho Lee7,
  19. Wing-Sun Chow7,
  20. Chung Wah Siu1,
  21. Chun Ka Wong1
  1. 1Cardiology Division, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong
  2. 2Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong, Hong Kong
  3. 3Medical Imaging Key Laboratory, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
  4. 4Department of Echocardiography & Non-invasive Cardiology Laboratory, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
  5. 5Department of Cardiology, Guangdong General Hospital, Guangzhou, China
  6. 6Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
  7. 7Endocrinology Division, Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
  1. Correspondence to Dr Chun Ka Wong, Cardiology Division, Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong; emmanuelckwong{at}gmail.com

Abstract

Background International guidelines recommend natriuretic peptide biomarker-based screening for patients at high heart failure (HF) risk to allow early detection. There have been few reports about the incorporation of screening procedure to existing clinical practice.

Objective To implement screening of left ventricular dysfunction in patients with type 2 diabetes mellitus (DM).

Method A prospective screening study at the DM complication screening centre was performed.

Results Between 2018 and 2019, 1043 patients (age: 63.7±12.4 years; male: 56.3%) with mean glycated haemoglobin of 7.25%±1.34% were recruited. 81.8% patients had concomitant hypertension, 31.1% had coronary artery disease, 8.0% had previous stroke, 5.5% had peripheral artery disease and 30.7% had chronic kidney disease (CKD) stages 3–5. 43 patients (4.1%) had an elevated N-terminal prohormone of brain natriuretic peptide (NT-proBNP) concentration above the age-specific diagnostic thresholds for HF, and 43 patients (4.1%) had newly detected atrial fibrillation (AF). The prevalence of elevated NT-proBNP increased with age from 0.85% in patients aged <50 years to 7.14% in those aged 70–79 years and worsening kidney function from 0.43% in patients with CKD stage 1 to 42.86% in CKD stage 5. In multivariate logistic regression, male gender (OR: 3.67 (1.47–9.16), p=0.005*), prior stroke (OR: 3.26 (1.38–7.69), p=0.007*), CKD (p<0.001*) and newly detected AF (OR: 7.02 (2.65–18.57), p<0.001*) were significantly associated with elevated NT-proBNP. Among patients with elevated NT-proBNP, their mean left ventricular ejection fraction (LVEF) was 51.4%±14.7%, and 45% patients had an LVEF <50%.

Conclusion NT-proBNP and ECG screening could be implemented with relative ease to facilitate early detection of cardiovascular complication and improve long-term outcomes.

  • heart failure
  • general diabetes

Data availability statement

Data are available upon reasonable request. Dataset used during the study will be available from the corresponding author on reasonable request from date of publication for 2 years.

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Data availability statement

Data are available upon reasonable request. Dataset used during the study will be available from the corresponding author on reasonable request from date of publication for 2 years.

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Footnotes

  • MZ and DH contributed equally.

  • Contributors CPL, WSY, M-LZ, LXY, YF, NT, JC, XLL, CHL, W-SC, CWS and CKW conceived and designed the protocol and study. MZ, DH, YC, YML, WHL, Y-ML, JH, HFT, CHL, W-SC, CWS and CKW contributed to data acquisition. MZ, DH, YC, YML, WHL, EWC, CHL, W-SC, CWS and CKW contributed to data interpretation and analysis. MZ, DH, CHL, CWS and CKW wrote the first draft of the manuscript. YC, EWC, WSY, M-LZ, LXY, YF, NT, JC and XLL revised the manuscript critically for important intellectual content. MZ, DH, CWS and CKW are responsible for the overall content as the guarantors. All authors have read and approved the final version of the manuscript to be published.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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