背景:糖尿病患者通过几种独立于传统心力衰竭危险因素的病理生理机制存在发展为心肌病的风险。在糖尿病心肌病(DbCM)患者中,利钠肽之间的关系,心脏结构异常和功能容量在很大程度上是未知的。
方法:在这个关于醛糖还原酶抑制在心力衰竭中稳定运动能力(ARISE-HF)试验的预设亚组分析中,685名无症状DbCM的参与者接受了基线超声心动图数据,实验室调查,和功能评估。参与者通过N末端B型利钠肽前体(NT-proBNP)四分位数进行分层,使用Spearman相关性检验评估与超声心动图和功能参数的相关性。
结果:NT-proBNP中位数为71(Q1,Q3:33,135)ng/L。未观察到NT-proBNP浓度与舒张或收缩功能障碍的超声心动图参数(包括整体纵向应变)之间的关联。左心室射血分数,左心室质量指数,左心房容积指数,E/E\',或者右心室收缩压.相比之下,NT-proBNP与堪萨斯城心肌病问卷总评分显著相关(rho=-0.10;p=0.007),老年人身体活动量表(rho=-0.12;p=0.004),心肺运动试验的持续时间(rho=-0.28;p<0.001),峰值VO2(rho=-0.26;p<0.001),和分钟通风/二氧化碳产量的比率(rho=0.12;p=0.002)。在对已知的混杂因素进行调整后,老年人体力活动量表与堪萨斯城心肌病问卷总评分的相关性不再显著。
结论:在亚临床DbCM患者中,NT-proBNP浓度升高与健康状况恶化有关,较低的活动水平,功能能力降低,但没有心脏结构异常.这些发现表明,无论心脏结构异常,生物标志物浓度反映了受影响个体功能能力的重要恶化。
背景:ARISE-HF,NCT04083339注册日期2019年8月23日。
BACKGROUND: Persons with diabetes are at risk for developing a cardiomyopathy through several pathophysiological mechanisms independent of traditional risk factors for heart failure. Among those with diabetic cardiomyopathy (DbCM), the relationship between natriuretic peptides, cardiac structural abnormalities and functional capacity is largely unknown.
METHODS: In this prespecified subgroup analysis of the Aldose Reductase Inhibition for Stabilization of Exercise Capacity in Heart Failure (ARISE-HF) trial, 685 participants with asymptomatic DbCM underwent baseline echocardiography data, laboratory investigations, and functional assessments. Participants were stratified by N-terminal pro-B type natriuretic peptide (NT-proBNP) quartiles, and correlation with echocardiographic and functional parameters were assessed using Spearman correlation test.
RESULTS: The median NT-proBNP was 71 (Q1, Q3: 33, 135) ng/L. No association was observed between NT-proBNP concentrations and echocardiographic parameters of either diastolic or systolic dysfunction including global longitudinal strain, left ventricular ejection fraction, left ventricular mass index, left atrial volume index, E/E\', or right ventricular systolic pressure. In contrast, NT-proBNP was significantly correlated with overall Kansas City Cardiomyopathy Questionnaire score (rho = - 0.10; p = 0.007), the Physical Activity Scale in the Elderly (rho = - 0.12; p = 0.004), duration of cardiopulmonary exercise testing (rho = - 0.28; p < 0.001), peak VO2 (rho = - 0.26; p < 0.001), and ratio of minute ventilation/carbon dioxide production (rho = 0.12; p = 0.002). After adjustment for known confounders, the correlation with Physical Activity Scale in the Elderly and overall Kansas City Cardiomyopathy Questionnaire score was no longer significant.
CONCLUSIONS: Among patients with subclinical DbCM, elevated NT-proBNP concentrations are associated with worse health status, lower activity levels, and reduced functional capacity, but not with cardiac structural abnormalities. These findings suggest that regardless of cardiac structural abnormalities, biomarker concentrations reflect important deterioration in functional capacity in affected individuals.
BACKGROUND: ARISE-HF, NCT04083339 Date Registered August 23, 2019.