Diagnostic value of B-natriuretic peptide, ankle brachial index and carotid doppler in detection of sub-clinical cardiovascular disease in type 2 diabetic patients

ABSTRACT

Diabetes is important as a cause of cardiovascular disease [CVD], ranging from asymptomatic ischemia to clinically evident heart failure. Therefore, early identification of sub-clinical CVD in diabetic patients may be particularly important in leading to early initiation of treatment. The aim of the present study was to identify role of BNP [Brain natriuretic Peptide]. Ankle Brachial Index [ABI] and carotid Doppler in detection of sub-clinical CVD in type 2 diabetic patients. BNP was measured in 60 consecutive diabetic patients [patients group] whom were attended internal medicine outpatient clinics or admitted at endocrinology unit of Assiut university hospital. Another 40 patients; were chosen as [control group] their age and sex matched with patients. Echocardiography examinations were performed to all participants. ABI measurements were eonducted on all study participants. Carotid intima Media Thickness [CIMT] and carotid Plaque were evaluated by Carotid Doppler Ultrasonography, along with the determination of anthropometric parameters, HbAlc, lipid profile, assessment of diabetic retinopathy, nephropathy, and neuropathy, in patients with type 2 diabetes mellitus [T2DM]. Our study revealed 11 patients had Left ventricular hypertrophy [LVH], 20 patients had Left Ventricular Diastolic Dysfunction [LVDD], and no systolic dysfunction were detected. BNP were independent determinants of mild to moderate LVDD. Prevalence of a low ABI [<0.9] was 18.3%. Patients with low ABI had significant increased mean ages [P=0.038] duration of DM [P=0.004], concentration of HbAlc [P=0.044], BNP [P=0.013] and microalbuminurea [P-0.007].Patients with low ABI significantly associated with nephropathy [P=0.001], retinopathy [P=0007], LVH [P=0.010] LVDD [P=0.018] and carotid artery atherosclerosis [P=0.018]. 20 patients [33.3%] were found to have evidence of carotid artery disease of them 5 patients [8.3%] had increased CIMT and 15 patients [25%] had carotid artery plaques, patients with carotid plaque were significantly smoker [P=0.008], male gender [P=0.013], had low HDL [P-0.008] and higher concentration of HbAlc [P=0.001]. Also patients with carotid artery atherosclerosis were significantly associated with nephropathy [P=0.000], neuropathy [P=0.050], Peripheral Arterial Disease [PAD] [P=0.018], LVDD [0.002].Conclusion: Our study showed that BNP discriminated patients at high risk for mild to moderate LVDD. A low ABI were prevalent in our study and associated with age, duration of diabetes, high HbAlc, microalbuminurea and chronic complication of DM, also carotid atherosclerosis high prevalent in our study especially carotid plaques which significantly associated with male gender, smoking, high HbAlc, low HDL, LVDD, PAD, and diabetic microangiopathy