https://imcjms.com Ibrahim Medical College Journal of Medical Science https://imcjms.com/registration/journal_full_text/64 Tue, 02 Aug 2016 11:53:53 +0000 The first stage of diabetic cardiomyopathy is represented by left ventricular diastolic dysfunction (LVDD) with preserved systolic function, in an asymptomatic patient. B-type Natriuretic Peptide (BNP) is a cardiac neurohormone predominantly released from the cardiac ventricles in response to left ventricular volume expansion and pressure overload. The diagnostic role of BNP for detecting LVDD in asymptomatic diabetic patients is still debated and this study was undertaken to find out this relationship of plasma BNP level with LVDD in asymptomatic diabetic patients. First 100 patients who had type 2 diabetes for more than 5 years and had no known cardiac disease other than LVDD (grade-1 & 2), admitted in BIRDEM Hospital were recruited. Plasma BNP was measured by fluorescence polarization immunoassay (FPIA) method using AXSYM auto analyzer. Two-dimensional, M-mode, spectral, and color flow Doppler echocardiograms was repeated on the same day of blood collection for plasma BNP measurement. After processing of all available data, statistical analysis of their significance was done with the help of computer based SPSS (Statistical Program for Social Science) program. Male female distribution of the study participants was 46% and 54% respectively. Mean plasma BNP level in all participants was 150 pg/ml. In male and female participants the values were 168 and 135 pg/ml respectively. The distribution did not show any significant association (p=0.491).  Of the 100 study participants 89% had E/A ratio <1. Distribution of participants with abnormal E/A and E/e did not show any significant association (p=0.955 and 0.844 respectively). Study participants with varying level of plasma BNP level were analyzed in terms of E/A and E/e ratio. Distribution of participants between BNP Groups and E/A and E/e groups did not show statistically significant association (p=0.529). We concluded that plasma BNP has no relation with LVDD (grade-1 and 2) in patients with type 2 diabetes mellitus (T2DM) who had no known cardiac disease. Introduction Great majority of the diabetic patients (80%) die of macrovascular complications, including coronary artery disease (CAD), stroke, and peripheral vascular disease (PVD).4  Cardiac involvement in diabetes covers a wide spectrum, ranging from asymptomatic silent ischemia to clinically evident heart failure.5  The first stage of diabetic cardiomyopathy is represented by left ventricular diastolic dysfunction (LVDD) with preserved systolic function, in an asymptomatic pattern.5-8 The global prevalence of diastolic dysfunction largely ranges from 30% to 75%, depending on the defined echocardiographic parameters.6,9-12 No data is available in Bangladesh. In India, the overall prevalence of LVDD in asymptomatic type 2 DM subjects is 54%.10 The diagnostic role of natriuretic peptides for detecting LVDD in asymptomatic diabetic patients is still debated.26,30-33  However, a single study in Bangladesh showed that raised plasma BNP level may indicate LVDD.34 Probably the reason of this association is the presence of high risk group of ischemic heart diseases (IHD) in their study population. Hence, this study was undertaken to find out the relationship of plasma BNP level with LVDD in patients with type 2 DM without any known cardiac disease. Subjects and Methods A total 100 adult patients with type 2 diabetes mellitus (T2DM) with duration of diabetes more than five years and diagnosed case of diastolic dysfunction without coronary artery disease (CAD) and congestive heart failure (CHF) were recruited. As the patients with diastolic dysfunction of grade-3 & 4 are symptomatic, they were excluded from our study. CAD and CHF were excluded according to history, physical findings, ECG and chest radiography (CXR). Any patients with ambiguous clinical features or borderline abnormal ECG & CXR for CAD and CHF were excluded.   After processing of all available data, statistical analysis of their significance was done. Obtained data were expressed in frequency, percentage, mean and standard deviation as applicable. Continuous variables were expressed as mean ± SD. Comparison between groups was done by the Student’s t-test where appropriate for continuous variables. Categorical data were analyzed by Chi-square test. The whole analyses was done with the help of computer based SPSS (Statistical Program for Social Science) program. P-value of <0.05 was considered as significant. Results Mean plasma BNP in all subjects was 150pg/ml. In male and female subjects the value was 168 and 135 pg/ml respectively.  Considering the nature of distribution of the variables median value for all subjects in either gender was calculated which were 93.6 pg/ml, 108 pg/ml and 89.8 pg/ml respectively. In subjects with Grade 1 LVDD (E/A ratio <1) plasma BNP was 137 (pg/ml) [SD-127; range-10-593]. In those with Grade 2 LVDD (E/e ratio ³10) plasma BNP level was   117 (pg/ml) [SD-91; range-31-384]. Mean plasma BNP level between the LVDD groups did not show significant statistical difference (p=0.448; Table 1). Table-1: Plasma BNP level in subjects with different grade of LVDD        Correlation analysis was performed between plasma BNP levels and variables of interest. Statistical significant association was lacking for any one of the target variables. Discussion An important limitation of this study was the lack of coronary angiographic (CAG) evaluation of coronary arteries and therefore, the inability to correlate the echocardiographic findings with underlying coronary artery disease. Because diabetes is notoriously associated with silent myocardial ischemia in up to 10-20% cases,39-41 asymptomatic patient with normal ECG would not exclude true cardiac ischemia. However, CAG is an expensive and time-consuming investigation to rule out CAD and is not always used to detect ischemic heart disease. Another important limitation was relative small size of the study population which was mainly due to lack of sufficient fund and time. In conclusion, the study  revealed that the plasma BNP level had no relation with LVDD (grade 1 and 2) in patients with T2DM without any known cardiac disease. Acknowledgement   1.    Wild S, Roglik G, Green A, Sicree R, King H. Global Prevalence of Diabetes. 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