MR-proANP and incident cardiovascular disease in patients with type 2 diabetes with and without heart failure with prese
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ORIGINAL INVESTIGATION
Cardiovascular Diabetology Open Access
MR‑proANP and incident cardiovascular disease in patients with type 2 diabetes with and without heart failure with preserved ejection fraction Jesper Jensen1,6* , Morten Schou1,6, Caroline Kistorp2,6, Jens Faber3,6, Tine W. Hansen4, Magnus T. Jensen5, Henrik U. Andersen4, Peter Rossing4,6, Tina Vilsbøll4,6 and Peter G. Jørgensen1
Abstract Background: Mid-regional pro-atrial natriuretic peptide (MR-proANP) is a useful biomarker in outpatients with type 2 diabetes (T2D) to diagnose heart failure (HF). Elevated B-type natriuretic peptides are included in the definition of HF with preserved ejection fraction (HFpEF) but little is known about the prognostic value of including A-type natriuretic peptides (MR-proANP) in the evaluation of patients with T2D. Methods: We prospectively evaluated the risk of incident cardiovascular (CV) events in outpatients with T2D (n = 806, mean ± standard deviation age 64 ± 10 years, 65% male, median [interquartile range] duration of diabetes 12 [6–17] years, 17.5% with symptomatic HFpEF) according to MR-proANP levels and stratified according to HF-status including further stratification according to a prespecified cut-off level of MR-proANP. Results: A total of 126 CV events occurred (median follow-up 4.8 [4.1–5.3] years). An elevated MR-proANP, with a cutoff of 60 pmol/l or as a continuous variable, was associated with incident CV events (p 40% and ≤ 50%, (b) ratio of early diastolic mitral inflow velocity (E) to early diastolic septal annular velocity (e′) (E/e′septal) ≥ 15, (c) increased left ventricular (LV) mass index (> 95 g/cm2 for women and > 115 g/cm2 for men), and (d) left atrial volume index > 34 mL/m2. HFrEF was defined as a LVEF ≤ 40%, regardless of reported dyspnea. The definitions were specified before the MRproANP analyses were performed. Follow‑up
Information on incident CV events were retrieved through national registries. A CV event was defined as
Jensen et al. Cardiovasc Diabetol
(2020) 19:180
the composite of admission with CV disease (including HF, coronary revascularization, myocardial infarction, cardiac arrest, cerebrovascular disease and peripheral artery disease) and CV death. Statistics
Baseline characteristics for all four groups were compared using a one-way analysis of variance for continuous variables and, in case of non-normal distribution, Mann– Whitney U tests or Kruskall-Wallis tests were used. Categorical variables were compared using the Chi-square test. MR-proANP levels were non-normally distributed and, therefore, log2-transformed before continuous analyses. Cumulative incidence curves with non-CV death as competing risk for incident CV events according to HF status were performed, and for HFpEF also according to the prespecified dichotomized MR-proANP level of 60 pmol/l. Moreover, a cumulative incidence curve for incident CV events according to the dichotomized MR-proANP level was performed with non-CV death as competing risk. Poisson regression with restricted cubic sp
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