Assessment of heart stress by age-dependent NT-proBNP thresholds for early diagnosis and prediction of cardiovascular outcomes in patients with type 2 diabetes mellitus
Introduction. The concept of “heart stress” is based on age-dependent NT-proBNP thresholds for stratifying patients and identifying those requiring further evaluation. The prognostic significance of this approach in diabetes mellitus type 2 (T2DM) patients remains insufficiently studied.N.I. Khutsishvili, I.S. Nazarov, A.F. Safarova, V.V. Tolkacheva, A.A. Abramov, Zh.D. Kobalava
Objective: To evaluate the prevalence of heart stress using age-dependent NT-proBNP thresholds in T2DM patients without established heart failure with preserved ejection fraction (HFpEF) diagnosis and its prognostic value for the risk of major adverse cardiovascular events over 12 months.
Material and methods. This prospective single-center study included 164 T2DM patients (65.9 ± 9.6 years, 56% women) without established heart failure. All underwent NT-proBNP measurement with interpretation according to age-dependent thresholds. Patients with heart stress and an intermediate probability of its presence (“gray zone”) underwent extended echocardiography. The endpoint was all-cause death and cardiovascular hospitalizations.
Results. The prevalence of heart stress was 46% (n = 75), “gray zone” – 29% (n=48), and normal values – 25% (n = 41). Patients with heart stress demonstrated more pronounced structural and functional cardiac abnormalities. Over 12 months, 30 events were recorded. Event rates were 28.0% in the heart stress group, 18.8% in the “gray zone”, and 0% in the normal group (χ² = 10.848; log-rank p = 0.004). For the first time in the Russian population of T2DM patients, it has been shown that 75% have elevated or borderline NT-proBNP levels requiring further evaluation. Heart stress is associated with structural and functional changes characteristic of HFpEF and is an independent predictor of adverse outcomes. Our findings are consistent with international studies.
Conclusion. Screening for heart stress using age-dependent NT-proBNP thresholds in T2DM patients allows identification of a high-risk group requiring further evaluation. Elevated NT-proBNP is associated with an increased risk of death and cardiovascular hospitalizations, supporting its use for early diagnosis and risk stratification.
Keywords
heart stress
N-terminal pro-brain natriuretic peptide (NT-proBNP)
type 2 diabetes mellitus
heart failure with preserved ejection fraction
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About the Authors
Nutsiko I. Khutsishvil, MD, assistant at the Department of internal medicine with a course in cardiology and functional diagnostics named after academician V.S. Moiseev of the Medical Institute, RUDN University, Moscow Russian Federation.Е-mail: nutsiko.khutsishvili@gmail.com
ORCID: https://orcid.org/0009-0009-2669-8092. Scopus ID: 58558552800. eLibrary SPIN: 3322-4387
Ivan S. Nazarov, MD, assistant at the Department of internal medicine with a course in cardiology and functional diagnostics named after academician V.S. Moiseev of the Medical Institute, RUDN University, Moscow Russian Federation.
E-mail: nazarovradomla@mail.ru
ORCID: https://orcid.org/0000-0002-0950-7487. Scopus ID: 57686928900. eLibrary SPIN: 5954-7828
Ayten F. Safarova, MD, Dr. Sci. (Medicine), professor of the Department of internal medicine with a course in cardiology and functional diagnostics named after academician V.S. Moiseev of the Medical Institute, RUDN University, Moscow Russian Federation.
E-mail: aytensaf@mail.ru
ORCID: https://orcid.org/0000-0003-2412-5986. eLibrary SPIN: 2661-6501
Veronika V. Tolkacheva, MD, Dr. Sci. (Medicine), professor of the Department of internal medicine with a course in cardiology and functional diagnostics named after academician V.S. Moiseev of the Medical Institute, RUDN University, Moscow Russian Federation.
E-mail: tolkachevav@mail.ru
ORCID: https://orcid.org//0000-0001-6847-8797. eLibrary SPIN: 2282-2127
Alexey A. Abramov, MD, postgraduate student of the Department of internal medicine with a course in cardiology and functional diagnostics named after academician V.S. Moiseev of the Medical Institute, RUDN University, Moscow Russian Federation.
Е-mail: aaabramov196@mail.ru
ORCID: https://orcid.org/0000-0002-9678-5871. eLibrary SPIN: 6915-3717
Zhanna D. Kobalava, MD, Dr. Sci. (Medicine), professor, corresponding member of RAS, head of the Department of internal medicine with a course in cardiology and functional diagnostics named after academician V.S. Moiseev of the Medical Institute, RUDN University, Moscow Russian Federation.
E-mail: zkobalava@mail.ru
ORCID: https://orcid.org/0000-0002-5873-1768. Scopus ID: 7004399203. eLibrary SPIN: 9828-5409
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