The Effect of Diabetes on B-Type Natriuretic Peptide Concentrations in Patients With Acute Dyspnea

An analysis from the Breathing Not Properly Multinational Study

  1. Alan H.B. Wu, PHD1,
  2. Torbjørn Omland, MD, PHD, MPH2,
  3. Philippe Duc, MD3,
  4. James McCord, MD4,
  5. Richard M. Nowak, MD, MBA5,
  6. Judd E. Hollander, MD6,
  7. Howard C. Herrmann, MD7,
  8. Philippe G. Steg, MD8,
  9. Cathrine Wold Knudsen, MD2,
  10. Alan B. Storrow, MD9,
  11. William T. Abraham, MD10,
  12. Alberto Perez, MD11,
  13. Richard Kamin, MD11,
  14. Paul Clopton, MSC, MD12,
  15. Alan S. Maisel, MD13,
  16. Peter A. McCullough, MD14 and
  17. for the Breathing Not Properly Multinational Study Investigators
  1. 1Department of Pathology and Laboratory Medicine, Hartford Hospital, Hartford, Connecticut
  2. 2Department of Cardiology, Ullevåll University Hospital, Oslo, Norway
  3. 3Service de Cardiologie, Hospital Bichat, Paris, France
  4. 4Heart and Vascular Institute, Henry Ford Hospital, Detroit, Michigan
  5. 5Department of Emergency Medicine, Henry Ford Hospital, Detroit, Michigan
  6. 6Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
  7. 7Cardiovascular Division, University of Pennsylvania, Philadelphia, Pennsylvania
  8. 8Department de Cardiologie, Hospital Bichat, Paris, France
  9. 9Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
  10. 10Division of Cardiovascular Medicine, University of Kentucky College of Medicine, Lexington, Kentucky
  11. 11Department of Emergency Medicine, Hartford Hospital, Hartford, Connecticut
  12. 12Statistical Research Department, University of California, San Diego, California
  13. 13Division of Cardiology, University of California, San Diego, California
  14. 14Division of Cardiology, William Beaumont Hospital, Royal Oak, Michigan
  1. Address correspondence and reprint requests to Alan H.B. Wu, PhD, DABCC, Department of Laboratory Medicine, San Francisco General Hospital, 1001 Potrero Ave., San Francisco, CA 94110. E-mail: wualan{at}labmed2.ucsf.edu

Abstract

OBJECTIVE—Diabetes has been implicated in reduced myocardial compliance and changes in the intercellular matrix of the myocardium. We determined the effect of diabetes on B-type natriuretic peptide (BNP) concentrations in patients presenting to the emergency department with dyspnea.

RESEARCH DESIGN AND METHODS—The Breathing Not Properly Multinational Study was a prospective evaluation of 1,586 patients. A subset of 922 patients was obtained and subdivided into the following groups: group 1 (n = 324), neither diabetes nor heart failure; group 2 (n = 107), diabetes and no heart failure; group 3 (n = 247), no diabetes and heart failure; group 4 (n = 183), both diabetes and heart failure; group 5 (n = 41), heart failure history with no diabetes; and group 6 (n = 20), heart failure history with diabetes. Patients from groups 1, 3, and 5 were matched to groups 2, 4, and 6, respectively, to have the same mean age, sex distribution, BMI, renal function, and New York Heart Association (NYHA) classification (for heart failure).

RESULTS—There was no significant difference in median BNP levels between diabetes and no diabetes among no heart failure patients (32.4 vs.32.9 pg/ml), heart failure patients (587 vs. 494 pg/ml), and those with a heart failure history (180 vs. 120 pg/ml). Receiver-operating characteristic curve analysis of the area under the curve for BNP was not different in diabetic versus nondiabetic patients (0.888 vs. 0.878, respectively). However, in a multivariate model, diabetes was an independent predictor of a final diagnosis of heart failure (odds ratio 1.51, 95% CI 1.03–2.02; P < 0.05).

CONCLUSIONS—History of diabetes does not impact BNP levels measured in patients with acute dyspnea in the emergency department. Despite the impact of diabetes on the cardiovascular system, diabetes does not appear to confound BNP levels in the emergency department diagnosis of heart failure.

Footnotes

  • A.H.B.W. holds stock in, has received honoraria from, and has received research support from Biosite Diagnostics. T.O. has received honoraria or consulting fees from Biosite Diagnostics, Bayer, and Roche. J.M. and P.C.A. have received honoraria or consulting fees from Biosite Diagnostics. R.M.N. has served on an advisory panel and received honoraria from Sepracor Pharmaceuticals. J.E.H. and A.S.M. have served on an advisory board for, received honoraria from, and received grant support from Biosite Diagnostics. W.T.A. has received research support from Biosite Diagnostics. P.A.M. has served on an advisory panel for and received honoraria from Biosite Diagnostics.

    A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

    • Accepted July 15, 2004.
    • Received April 12, 2004.
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  1. doi: 10.2337/diacare.27.10.2398 Diabetes Care October 2004 vol. 27 no. 10 2398-2404
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