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Abstract：
BACKGROUND: We evaluated the prevalence of \"heart stress\" (HS) based on NT-proBNP cut-points proposed by the 2023 Consensus of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC) in asymptomatic patients with T2DM and hypertension or high-normal blood pressure (BP) eligible for SGLT2 inhibitors (SGLT2i) and/or GLP-1 receptor agonists (GLP1-RA), drugs with proven benefits on reducing the incidence of HF, hospitalizations, cardiovascular events and mortality.
METHODS: A cross-sectional multicentric study was conducted on 192 consecutive outpatients, aged ≥ 55 years, with hypertension or high-normal BP, referred to three diabetology units. NT-proBNP was collected before starting new anti-diabetic therapy. Patients with known HF were excluded, and participants were classified based on the age-adjusted NT-proBNP cut-points.
RESULTS: Mean age: 70.3 ± 7.8 years (67.5% males). Patients with obesity (BMI ≥ 30 Kg/m2): 63.8%. Median NT-proBNP: 96.0 (38.8-213.0) pg/mL. Prevalence of chronic kidney disease (CKD, eGFR < 60 mL/min/1.73m2): 32.1%. Mean arterial BP: 138.5/77.0 ± 15.8/9.9 mmHg. The NT-proBNP values, according to the proposed age-adjusted cut-points, classified 28.6% of patients as \"HS likely\" (organize elective echocardiography and specialist evaluation), 43.2% as \"HS not likely\" (a grey area, repeat NT-proBNP at six months) and 28.2% as \"very unlikely HS\" (repeat NT-proBNP at one year). The presence of CKD and the number of anti-hypertensive drugs, but not glycemic parameters, were independently associated with HS.
CONCLUSIONS: According to NT-proBNP, over a quarter of T2DM patients with hypertension/high-normal BP, among those eligible for SGLT2i and/or GLP1-RA, were already at risk of cardiac damage, even subclinical. Most would receive an indication to echocardiogram and be referred to a specialist, allowing the early implementation of effective strategies to prevent or delay the progression to advanced stages of cardiac disease and overt HF.
METHODS: A cross-sectional multicentric study was conducted on 192 consecutive outpatients, aged ≥ 55 years, with hypertension or high-normal BP, referred to three diabetology units. NT-proBNP was collected before starting new anti-diabetic therapy. Patients with known HF were excluded, and participants were classified based on the age-adjusted NT-proBNP cut-points.
RESULTS: Mean age: 70.3 ± 7.8 years (67.5% males). Patients with obesity (BMI ≥ 30 Kg/m2): 63.8%. Median NT-proBNP: 96.0 (38.8-213.0) pg/mL. Prevalence of chronic kidney disease (CKD, eGFR < 60 mL/min/1.73m2): 32.1%. Mean arterial BP: 138.5/77.0 ± 15.8/9.9 mmHg. The NT-proBNP values, according to the proposed age-adjusted cut-points, classified 28.6% of patients as \"HS likely\" (organize elective echocardiography and specialist evaluation), 43.2% as \"HS not likely\" (a grey area, repeat NT-proBNP at six months) and 28.2% as \"very unlikely HS\" (repeat NT-proBNP at one year). The presence of CKD and the number of anti-hypertensive drugs, but not glycemic parameters, were independently associated with HS.
CONCLUSIONS: According to NT-proBNP, over a quarter of T2DM patients with hypertension/high-normal BP, among those eligible for SGLT2i and/or GLP1-RA, were already at risk of cardiac damage, even subclinical. Most would receive an indication to echocardiogram and be referred to a specialist, allowing the early implementation of effective strategies to prevent or delay the progression to advanced stages of cardiac disease and overt HF.
摘要：
背景：我们根据欧洲心脏病学会（ESC）2023年心力衰竭协会共识（HFA）提出的NT-proBNP指标评估了“心脏应激”（HS）的患病率无症状的T2DM和高血压或符合SGLT2抑制剂（SGLTi）和/或GLP-1受体激动剂（GLP1-GRA）的正常血压（BP）已证明对降低HF发病率有益的药物，住院治疗,心血管事件和死亡率。
方法：对192名连续门诊患者进行了一项横断面多中心研究，年龄≥55岁，高血压或正常血压较高，提到了三个糖尿病科。在开始新的抗糖尿病治疗之前收集NT-proBNP。已知HF患者被排除在外，参与者根据年龄校正的NT-proBNP临界点进行分类.
结果：平均年龄：70.3±7.8岁（男性占67.5％）。肥胖患者（BMI≥30Kg/m2）：63.8%。NT-proBNP中位数:96.0(38.8-213.0)pg/mL。慢性肾脏病（CKD，eGFR<60mL/min/1.73m2):32.1%。平均动脉血压：138.5/77.0±15.8/9.9mmHg。NT-proBNP值，根据拟议的年龄调整后的切入点，将28.6%的患者归类为“HS可能”(组织选择性超声心动图和专家评估)，43.2%为“HS不太可能”(灰色区域，6个月时重复NT-proBNP)和28.2%为“极不可能HS”(一年时重复NT-proBNP)。CKD的存在和抗高血压药物的数量，但不是血糖参数，与HS独立相关。
结论：根据NT-proBNP，超过四分之一的T2DM患者患有高血压/正常血压高，在符合SGLT2i和/或GLP1-RA资格的人中，已经有心脏损伤的危险,甚至亚临床。大多数人会收到超声心动图的指示，并转诊给专家，允许早期实施有效的策略，以防止或延迟进展到晚期的心脏疾病和明显的HF。
方法：对192名连续门诊患者进行了一项横断面多中心研究，年龄≥55岁，高血压或正常血压较高，提到了三个糖尿病科。在开始新的抗糖尿病治疗之前收集NT-proBNP。已知HF患者被排除在外，参与者根据年龄校正的NT-proBNP临界点进行分类.
结果：平均年龄：70.3±7.8岁（男性占67.5％）。肥胖患者（BMI≥30Kg/m2）：63.8%。NT-proBNP中位数:96.0(38.8-213.0)pg/mL。慢性肾脏病（CKD，eGFR<60mL/min/1.73m2):32.1%。平均动脉血压：138.5/77.0±15.8/9.9mmHg。NT-proBNP值，根据拟议的年龄调整后的切入点，将28.6%的患者归类为“HS可能”(组织选择性超声心动图和专家评估)，43.2%为“HS不太可能”(灰色区域，6个月时重复NT-proBNP)和28.2%为“极不可能HS”(一年时重复NT-proBNP)。CKD的存在和抗高血压药物的数量，但不是血糖参数，与HS独立相关。
结论：根据NT-proBNP，超过四分之一的T2DM患者患有高血压/正常血压高，在符合SGLT2i和/或GLP1-RA资格的人中，已经有心脏损伤的危险,甚至亚临床。大多数人会收到超声心动图的指示，并转诊给专家，允许早期实施有效的策略，以防止或延迟进展到晚期的心脏疾病和明显的HF。
