![]() Kaplan–Meier curves for all-cause mortality and cumulative incidence curves for MACE were estimated and differences between groups were compared by use of Log rank and Gray’s test respectively. Differences in baseline characteristics according to levels of NT-proBNP were tested using a χ 2-test for categorical variables and ANOVA or Kruskal–Wallis’s test for continuous variables. HbA 1c was measured by HPLC (normal range: 21–46 mmol/mol, (4.1–6.4%) Variant Bio-Rad Laboratories) and serum creatinine concentration by an enzymatic method (Hitachi 912 Roche Diagnostics).īaseline characteristics are described by use of proportions for categorical variables and means, with standard deviations, or medians, with quartiles, for continuous variables. Albuminuria was measured in 24-h sterile urine collections by use of enzymes immunoassays and micro- and macroalbuminuria were defined as urinary albumin excretion rates of 30 to 299 mg/24 h and ≥300 mg/24 h, respectively. A cut-off of 300 pg/mL was chosen as this is the best documented level of NT-proBNP for exclusion of acutely decompensated heart failure ( 23, 24, 25). Furthermore a cut-off of 150 pg/mL has a high negative predictive value of heart failure in a primary care setting ( 22). A cut-off for NT-proBNP of 150 pg/mL was chosen based on data from the general population, showing that individuals with levels ≥150 pg/mL had significantly higher risks of cardiovascular events and death ( 21). NT-proBNP was measured by use of MAGLUMI™ 800 Chemiluminescence Immunoassay (Snibe Diagnostics). ![]() We examined the prognostic importance of NT-proBNP and E/e′ in type 1 diabetes patients with preserved ejection fraction and without known heart disease in the Thousand and 1 Study.Īll samples were collected at baseline. We do not know whether the individual and combined value of echocardiographic and hormonal indices of diastolic dysfunction and increased filling pressure improve the prognostic accuracy in patients with type 1 diabetes. Diastolic dysfunction is a hallmark of diabetic cardiomyopathy and therefore has particular relevance in the assessment of myocardial function in patients with type 1 diabetes ( 17). E/e′ is used routinely in the clinical setting for the assessment of diastolic dysfunction and can predict events across different populations ( 11, 12, 13, 14, 15, 16). E/e′ is a marker of left ventricular filling pressure and diastolic function ( 10). In echocardiography, E/e′ is the ratio between early mitral inflow into the left ventricle (E) and the early diastolic filling velocity of the left ventricular mitral annulus (e′). For this reason, NT-proBNP is now measured routinely in these patients ( 7, 8, 9). In patients with heart failure, it is well established that levels of the NT-proBNP are predictive of adverse clinical outcomes. N-terminal pro-B-type natriuretic peptide (NT-proBNP) has been shown to be an independent predictor of cardiovascular and all-cause mortality in type 1 diabetes patients with diabetic nephropathy ( 6). Levels of natriuretic peptides increase in response to myocardial wall stretch, and by inhibition of the renin–angiotensin–aldosterone system, natriuresis and reduced vascular tone they are believed to exert a protective function ( 5). ![]() Thus, no routine assessment of myocardial function is performed in the clinical control of type 1 diabetes and the importance of such is not known. However, none of these models have included metrics of myocardial function. Several parameters have been identified as independent predictors of cardiovascular disease in patients with type 1 diabetes, including age, sex, diabetes duration, haemoglobin A1c (HbA1c), blood pressure, renal function, smoking status and physical activity ( 3, 4). Cardiovascular disease is common and the leading cause of death in patients with type 1 diabetes ( 1, 2).
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