B-type natriuretic peptide efficacy compared to fragmented QRS for diastolic dysfunction screening in patients with type 2 diabetes

Table 1 Clinical characteristics of the study population, mean ± SD/n (%)

Characteristic	Total (n = 303)	Overweight (n = 140)	Non-overweight (n = 163)	P value
Age, years	67.4 ± 12.3	63.5 ± 13.5	70.7 ± 10.0	< 0.0001
Male sex	191 (63.0)	74 (52.9)	117 (71.8)	0.0010
Duration of diabetes, years	15.9 ± 11.7	13.9 ± 9.8	17.6 ± 12.9	0.0047
Systolic BP, mmHg	134.8 ± 17.7	137.0 ± 16.7	132.8 ± 18.3	0.0371
Diastolic BP, mmHg	81.0 ± 12.0	83.4 ± 10.6	79.0 ± 12.8	0.0013
Heart rate, /minute	73.0 ± 13.0	75.1 ± 12.8	71.2 ± 12.9	0.0094
CAD	72 (23.8)	31 (22.1)	41 (25.2)	0.6323
BMI, kg/m2	25.2 ± 5.0	29.3 ± 4.1	21.7 ± 2.2	< 0.0001
eGFR, mL/minute	71.9 ± 25.3	74.5 ± 26.1	69.7 ± 24.5	0.1035
ALT, U/L	27.9 ± 23.3	29.6 ± 23.3	26.5 ± 23.4	0.2566
LDL-C, mmol/L	2.74 ± 0.90	2.88 ± 0.92	2.62 ± 0.86	0.0108
TG, mmol/L	1.61 ± 0.91	1.82 ± 1.00	1.42 ± 0.79	0.0002
HbA1c, %	9.5 ± 1.6	9.5 ± 1.6	9.5 ± 1.7	0.9957
HbA1c, mmol/mol	80 ± 18	80 ± 18	80 ± 19
UAE, mg/g	192.1 ± 512.4	167.9 ± 432.9	213.1 ± 572.8	0.4365
BNP, pg/mL	38.5 ± 65.6	29.1 ± 48.7	46.5 ± 76.4	0.0169
Medications
Insulin	116 (37.2)	55 (36.9)	61 (35.5)	0.8306
GLP-1a	37 (12.2)	32 (22.9)	5 (3.1)	0.0031
SGLT2i	27 (8.9)	19 (13.6)	8 (4.9)	0.0148
RASi	124 (40.9)	65 (46.4)	59 (36.2)	0.097
Beta blockers	47 (15.5)	22 (15.7)	25 (15.3)	0.004
Diuretics	69 (22.8)	43 (30.7)	26 (16.0)	0.168
TTE findings
LAD, mm	36.8 ± 6.0	37.6 ± 5.4	36.1 ± 6.4	0.0251
LVDD, mm	45.1 ± 5.0	45.8 ± 5.0	44.6 ± 4.9	0.0299
IVS, mm	9.4 ± 1.3	9.7 ± 1.2	9.2 ± 1.3	0.0013
EF, %	67.4 ± 7.2	67.0 ± 7.4	67.7 ± 7.1	0.4056
Septal E/E’	12.0 ± 4.1	12.1 ± 3.9	12.0 ± 4.3	0.9078
Lateral E/E’	9.1 ± 3.4	9.1 ± 3.4	9.0 ± 3.4	0.7779
Average E/E’	10.6 ± 3.5	10.6 ± 3.4	10.5 ± 3.6	0.8230
Septal E’, m/second	5.6 ± 1.7	5.6 ± 1.9	5.5 ± 1.6	0.6822
Lateral E’, m/second	7.5 ± 2.3	7.5 ± 2.6	7.4 ± 2.1	0.7016
TRV, m/second	2.3 ± 0.3	2.3 ± 0.2	2.3 ± 0.4	0.8226
E/A	0.81 ± 0.26	0.82 ± 0.27	0.80 ± 0.26	0.5415
Diastolic dysfunction	74 (24.4)	32 (22.9)	42 (25.8)	0.5933
ECG findings
Blocks
AVB	4 (1.3)	2 (1.4)	2 (1.2)	1.0000
RBBB	25 (8.3)	8 (5.7)	17 (10.4)	0.2013
LBBB	2 (0.7)	1 (0.7)	1 (0.6)	1.0000
fQRS	112 (37.0)	46 (32.9)	66 (40.5)	0.2102
fQRS region
Inferior leads	95 (31.4)	42 (30.0)	53 (32.5)	0.7291
Anterior leads	44 (14.5)	14 (10.0)	30 (18.4)	0.0566
Lateral leads	11 (3.6)	4 (2.9)	7 (4.3)	0.7197
Multiple regions	34 (11.2)	10 (7.1)	24 (14.7)	0.0572
fQRS morphologies
Fragmented QRS	15 (5.0)	3 (2.1)	12 (7.4)	0.1966
RSR’	11 (3.6)	3 (2.1)	8 (4.9)	0.3296
Notched S	82 (27.1)	38 (27.1)	44 (27.0)	1.0000
RSR’	13 (4.0)	3 (2.1)	10 (5.5)	0.2270
Notched R	87 (28.7)	36 (25.7)	51 (31.3)	0.3463
RSR’ with ST elevation	3 (1.0)	1 (0.7)	2 (1.2)	1.0000

BP: Blood pressure; CAD: Coronary artery disease; BMI: Body mass index; eGFR: Estimated glomerular filtration rate; ALT: Alanine aminotransferase; LDL-C: Low density lipoprotein cholesterol; TG: Triglyceride; HbA1c: Glycated hemoglobin; UAE: Urinary albumin excretion; BNP: Brain natriuretic peptide; GLP-1a: Glucagon-like peptide-1 receptor agonist; SGLT2i: Sodium-dependent glucose transporters 2 inhibitors; RASi: Renin-angiotensin-aldosterone system inhibitors; TTE: Transthoracic echocardiography; LAD: Left atrial diameter; LVDD: Left ventricular diastolic diameter; IVS: Interventricular septal thickness; EF: Left ventricular ejection fraction; E/E’: E-wave to E’ ratio on tissue Doppler imaging; TRV: Tricuspid valve regurgitation velocity; E/A: Ratio of peak early diastolic to peak atrial systolic transmitral flow velocities; ECG: Electrocardiography; AVB: Atrioventricular block; RBBB: Right bundle branch block; LBBB: Left bundle branch block; fQRS: Fragmented QRS.

Table 2 Multivariate model analysis on the diastolic dysfunction diagnosis in non-overweight participants

Factors	OR	95%CI	P value
Model 1; AIC: 181.33
Age, 10-year increments	1.59	1.04-2.57	0.044
Sex, male/female	0.52	0.23-1.19	0.118
CAD	0.84	0.33-2.06	0.715
sBP, every 10 mmHg	1.18	0.96-1.47	0.122
HR, every 10/minute	0.98	0.71-1.34	0.881
BNP, per SD	1.69	1.10-2.81	0.028
Model 2; AIC: 176.14
Age, 10-year increments	1.75	1.14-2.84	0.028
Sex, male/female	0.38	0.16-090	0.055
CAD	0.88	0.33-2.21	0.794
sBP, every 10 mmHg	1.22	0.99-1.53	0.073
HR, every 10/minute	0.89	0.65-1.22	0.478
fQRS	3.76	1.71-8.72	0.001
Model 3; AIC: 171.06
Age, 10-year increments	1.59	1.02-2.60	0.047
Sex, male/female	0.40	0.16-0.96	0.040
CAD	0.66	0.24-1.72	0.410
sBP, every 10 mmHg	1.23	0.99-1.54	0.067
HR, every 10/minute	0.96	0.69-1.31	0.786
BNP, per SD	1.89	1.16-3.39	0.023
fQRS	4.17	1.86-9.88	< 0.001

OR: Odds ratio; CI: Confidence interval; AIC: Akaike’s information criterion; BNP: Brain natriuretic peptide; CAD: Coronary artery disease; fQRS: Fragmented QRS; HR: Heart rate; sBP: Systolic blood pressure.

Table 3 Multivariate model analysis on the diastolic dysfunction diagnosis in overweight participants

Factors	OR	95%CI	P value
Model 1; AIC: 128.79
Age, 10-year increments	2.22	1.43-3.71	< 0.001
Sex, male/female	1.06	0.41-2.79	0.908
CAD	0.30	0.07-1.01	0.068
sBP, every 10 mmHg	1.66	0.72-2.30	< 0.001
HR, every 10/minute	1.91	1.29-2.99	0.002
BNP, per SD	1.19	0.77-1.82	0.387
Model 2; AIC: 114.95
Age, 10-year increments	2.60	1.57-4.77	< 0.001
Sex, male/female	0.87	0.30-2.48	0.790
CAD	0.18	0.03-0.71	0.024
sBP, every 10 mmHg	1.75	1.28-2.51	< 0.001
HR, every 10/minute	1.82	1.18-2.96	0.010
fQRS	7.15	2.55-22.4	< 0.001
Model 3; AIC: 116.52
Age, 10-year increments	2.57	1.55-4.72	< 0.001
Sex, male/female	0.87	3.03-2.48	0.789
CAD	0.17	0.03-0.69	0.022
sBP, every 10 mmHg	1.73	1.27-2.48	0.001
HR, every 10/minute	1.87	1.21-3.05	0.008
BNP, per SD	1.16	0.71-1.78	0.497
fQRS	7.07	2.51-22.2	< 0.001

OR: Odds ratio; CI: Confidence interval; AIC: Akaike’s information criterion; BNP: Brain natriuretic peptide; CAD: Coronary artery disease; fQRS: Fragmented QRS; HR: Heart rate; sBP: Systolic blood pressure.