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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
B-type natriuretic peptide efficacy compared to fragmented QRS for diastolic dysfunction screening in patients with type 2 diabetes
Kunimasa Yagi, Daisuke Chujo, Isao Usui, Jian-Hui Liu, Atsushi Nohara, Asako Enkaku Shirozu, Akiko Takikawa, Hisae Honoki, Shiho Fujisaka, Hideki Origasa, Hayato Tada
Kunimasa Yagi, Department of Internal Medicine, Kanazawa Medical University Hospital, Kahoku 920-0293, Ishikawa, Japan
Daisuke Chujo, Center for Clinical and Translational Research, Toyama University Hospital, Toyama 930-0152, Toyama, Japan
Isao Usui, Department of Endocrinology and Metabolism, Dokkyo Medical University, Utsunomiya 321-0293, Tochigi, Japan
Jian-Hui Liu, Department of Cardiology, Ningbo Medical Center of Lihuili Hospital, Ningbo 315041, Zhejiang Province, China
Atsushi Nohara, Department of Clinical Genetics, Ishikawa Prefectural Central Hospital, Kanazawa 920-8530, Ishikawa, Japan
Asako Enkaku Shirozu, Akiko Takikawa, Hisae Honoki, Shiho Fujisaka, The First Department of Internal Medicine, Toyama University Hospital, Toyama 930-0152, Toyama, Japan
Hideki Origasa, Data Science and AI Innovation Research Promotion Center, Institute of Statistical Mathematics, Shiga University, Hikone 525-0034, Shiga, Japan
Hayato Tada, Division of Cardiovascular Medicine, Kanazawa University, Graduate School of Medicine, Kanazawa 920-8640, Ishikawa, Japan
Author contributions: Yagi K acquired funding; Yagi K, Usui I, and Nohara A contributed to the design of the study; Chujo D, Liu JH, Shirozu AE, Takikawa A, Honoki H, and Fujisaka S contributed to the data curation; Yagi K, Origasa H, and Tada H participated in the statistical analysis; Yagi K wrote the original draft; Chujo D, Usui I, Liu JH, Nohara A, Origasa H, and Tada H participated in the review and editing; All the authors approved the final draft of the manuscript.
Supported by the JSPS KAKENHI, No. JP21K10300 and No. JP24K02714.
Institutional review board statement: This study was reviewed and approved by the Institutional Review Board of the Ethics Committee of Toyama University Hospital (No. R2020141).
Informed consent statement: All participants provided informed consent and web-based notifications were used to inform them of their right to opt out at any time.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
STROBE statement: The authors have read the STROBE Statement—a checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-a checklist of items.
Data sharing statement: Data supporting the findings of this study are available from the corresponding author upon reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Kunimasa Yagi, MD, PhD, Professor, Department of Internal Medicine, Kanazawa Medical University Hospital, 1-1 Daigaku, Uchinada, Kahoku 920-0293, Ishikawa, Japan.
yagikuni@icloud.com
Received: November 25, 2024
Revised: January 4, 2025
Accepted: January 21, 2025
Published online: April 15, 2025
Processing time: 98 Days and 3.7 Hours
BACKGROUND
Early diagnosis of left ventricular diastolic dysfunction (LVDD) is essential for preventing heart failure. B-type natriuretic peptide (BNP) is a viable marker for predicting LVDD, as elevated BNP levels have been associated with worsening LVDD in patients with diabetes over time. However, the utility of BNP as a diagnostic marker in diabetes is controversial, as BNP levels are often low in overweight individuals.
AIM
To examine the effectiveness of BNP levels and fragmented QRS (fQRS) on electrocardiography for diagnosing LVDD in patients with type 2 diabetes.
METHODS
This retrospective cohort study included 303 patients with type 2 diabetes (67.4 ± 12.3 years old) with preserved ejection fraction (EF) ≥ 50% admitted to Toyama University Hospital for glycemic management and comorbidity evaluation between November 2017 and April 2021. All participants underwent plasma BNP measurement, electrocardiography, and echocardiography. Cardiologists who were blinded to the BNP results assessed the electrocardiograms and echocardiograms. Subgroup analyses were conducted for overweight individuals.
RESULTS
Receiver operating characteristic (ROC) curve analysis determined optimal BNP cut-off values of 34.8 pg/mL and 7.2 pg/mL for diagnosing LVDD in non-overweight [area under the ROC curve (AUC): 0.70] and overweight (AUC: 0.55) groups, respectively (P = 0.040). In the overweight subgroup, fQRS showed greater diagnostic accuracy for LVDD (AUC: 0.67), indicating moderate diagnostic utility compared with the low performance of the BNP cutoff of 35 pg/mL (AUC: 0.52) (P = 0.010). Multivariate analyses confirmed that fQRS was superior to BNP for LVDD diagnosis regardless of the patient’s weight.
CONCLUSION
A BNP level ≥ 35 pg/mL in non-overweight individuals may be a reliable LVDD marker. Additionally, fQRS was more effective than BNP in diagnosing LVDD irrespective of the patient’s weight. fQRS can complement BNP in the early detection of LVDD, especially in overweight patients, potentially improving early detection and mitigating progression to heart failure with preserved EF in patients with type 2 diabetes.
Core Tip: Early diagnosis of left ventricular diastolic dysfunction (LVDD) is critical for preventing heart failure in patients with type 2 diabetes. The effectiveness of B-type natriuretic peptide (BNP) measurement for diagnosing LVDD in patients with type 2 diabetes remains controversial. BNP levels may underestimate the severity of LVDD because of their lower values in individuals with high body mass index or insulin resistance. A fragmented QRS (fQRS) on electrocardiography mainly reflects myocardial fibrosis and has been reported to reflect diastolic dysfunction in individuals with type 2 diabetes. Here, we compared the diagnostic efficacy of BNP and fQRS for LVDD, highlighting the utility of fQRS evaluation.
