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Objective: To find out whether B-type natriuretic peptide(BNP) detects silent myocardial ischaemia in patients with type 2 diabetes, since many of these patients have silent ischaemia leading to unexpected cardiac deaths. Design: Prospective cross-sectional study with consecutive recruitment of patients. Setting: Outpatient, single centre. Patients: 219 patients with type 2 diabetes. Patients were excluded if they had a history or evidence of cardiac failure. Outcome measures: BNP, echocardiography and exercise tolerance test(ETT). BNP was compared with the ETT result in all patients and specifically in those who had no apparent ischaemic heart disease(IHD). Results: 121 patients had no history of IHD or cardiac failure and of these patients 85 had a clearly abnormal or normal ETT result. BNP was higher in patients with an abnormal than with a normal ETT(mean 58.2(SD 46.3) v 24.4(SD 15.7) pg/ml, p< 0.001). In univariate analysis BNP was an independent predictor of an abnormal ETT(p< 0.001). In multivariate analysis BNP remained an independent predictor of the ETT result. BNP concentration over 20 pg/ml predicted an abnormal ETT result with a sensitivity of 87%and specificity of 37%, and BNP over 40 pg/ml had a sensitivity of 63%and a specificity of 81%. Conclusion: BNP is of value in predicting silent ischaemia on exercise testing in asymptomatic patients with type 2 diabetes.
Objective: To find out whether B-type natriuretic peptide (BNP) detects silent myocardial ischaemia in patients with type 2 diabetes, since many of these patients have silent ischaemia leading to unexpected cardiac deaths. Design: Prospective cross-sectional study with consecutive recruitment of Patients: 219 patients with type 2 diabetes. Patients were excluded if they had a history or evidence of cardiac failure. Outcome measures: BNP, echocardiography and exercise tolerance test (ETT). BNP was compared with the ETT result in all patients and specifically in those who had no apparent ischemic heart disease (IHD). Results: 121 patients had no history of IHD or cardiac failure and of these patients 85 had a distinct abnormal or normal ETT result. in patients with an abnormal than normal ETT (mean 58.2 (SD 46.3) v 24.4 (SD 15.7) pg / ml, p <0.001). 001). In multivariate analysis BNP remained an independent predictor of the ETT result. BNP concentration over 20 pg / ml predicted an abnormal ETT result with a sensitivity of 87% and specificity of 37%, and BNP over 40 pg / ml had a sensitivity of 63% and a specificity of 81%. Conclusion: BNP is of value in predicting silent ischaemia on exercise testing in asymptomatic patients with type 2 diabetes.