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European Heart Journal Advance Access published online on July 23, 2008
European Heart Journal, doi:10.1093/eurheartj/ehn334
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

NT-proBNP has a high negative predictive value to rule-out short-term cardiovascular events in patients with diabetes mellitus

Martin Huelsmann1,{dagger}, Stephanie Neuhold1,{dagger}, Guido Strunk2, Deddo Moertl1, Rudolf Berger1, Rudolf Prager3, Heidemarie Abrahamian3, Michaela Riedl4, Richard Pacher1,*, Anton Luger4 and Martin Clodi4

1 Department of Cardiology, Medical University Vienna, Vienna, Austria
2 Research Institute for Health Care Management and Economics, University of Economics and Business Administration, Vienna, Austria
3 Third Department of Medicine, Hietzing Hospital, Vienna, Austria
4 Department of Endocrinology, Medical University, Vienna, Austria

Received 24 January 2008; revised 24 June 2008; accepted 27 June 2008.

* Corresponding author. Tel: +43 1 40400 4614, Fax: +43 1 40400 6278, Email: richard.pacher{at}meduniwien.ac.at

Aims: This study evaluated the predictive value of NT-proBNP for patients with diabetes mellitus and compared the prognostic aptitude of this neurohumoral marker to traditional markers of cardiovascular events.

Methods and results: A prospective observational study was conducted in 631 diabetic patients. The composite endpoint consisted of unplanned hospitalization for cardiovascular events or death within the observation period of 12 months. Of all variables analysed (age, gender, history of hypertension, ischaemic heart disease/any cardiac disease, smoking, duration of diabetes, body mass index, blood pressure, New York Heart Association-class, Dyspnoea score, Minnesota Living with Heart Failure Questionnaire, LDL-cholesterol, HbA1c, creatinine, glomerular filtration rate), the logarithm of NT-proBNP gave the most potent information in a stepwise Cox regression analysis (P < 0.0001). Bootstrapping with 500 samples supports this result in 95% samples. The negative predictive value of a normal value (<125 pg/mL) of NT-proBNP for short-term cardiovascular events in diabetic patients is 98%.

Conclusion: We have demonstrated a strong and independent correlation between NT-proBNP and short-term prognosis of cardiovascular events for patients with diabetes mellitus. With a high negative predictive value it can identify individuals who are not at intermediate risk for cardiovascular events. NT-proBNP proved to be of higher predictive value than traditional cardiovascular markers, in this unselected cohort.

Key Words: Natriuretic peptides • Diabetes mellitus • Cardiovascular risk • Prognosis

{dagger} These authors contributed equally to this work


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