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Clinical usefulness of brain natriuretic peptide to assess the diabetic cardiac disorder
Track 2. Clinical Research & Care PI190 Electrocardiographic Abnormalities and Dyslipidaemia in Jamaican Diabetics ROSEMARIE A. WRIGHT-PASCOE. Department of Medicine, The
University of the West Indies, Mona, Jamaica Jamaica has one of the highest age-adjusted mortality rates from diabetes in Latin America and the Caribbean. Death is predominantly from cardiovascular disease yet the prevalence of ischaemic heart disease (IHD) and dyslipidaemia in Jamaican diabetics is not known. The objective of the study was to investigate the prevalence of IHD and dyslipidaemia in Jamaican diabetics. A retrospective analysis of the charts of 180 diabetics seen at 2 clinics run by the Diabetes Association of Jamaica was done. The mean age was 55.0 (12 -83) years. 68.3% were female. The mean systolic blood pressure (BP) was 139 (80 - 260); diastolic BP 82 (50 -130)mmHg and random glucose 12.5 (1.6 - 27.8) mmol/1. 72.7% had a glycosylated hemoglobin greater than 1% above the norm. 49.3% had hypertension. 2.4% had a past history of angina or IHD. 13% had angina. The electrocardiogram was abnormal in 58.1%. 10.7% had ST segment depression 2mm and more, 12.8% T wave inversion 2 mm and more. Other abnormalities included left axis deviation (2), old myocardial infarction (2), bifascicular block (1), left bundle branch block (1), premature ventricular contractions (2), atrial flutter (1), sinus tachycardia (6), poor R wave progression (9) and nonspecific S-T, T wave changes (16). 15.6% had left ventricular hypertropohy. Total cholesterol >6.2 was seen in 11.2%; increased low density lipoprotein cholesterol >3.4 in 74.4% and decreased high density lipoprotein cholesterol <0.9 mmol/1 in 8.6%. The triglyceride was >2.3 mmol/l in 9.4% and the TC/HDL-C ratio was >4.5 in 11 of 23 patients. A large number of a symptomatic Jamaican diabetics have significantly abnormal resting ECG's which required further evaluation. Dyslipidaemia is common in this high-risk population.
Pl191 Is the Activity of VWF Increased in ~ II Diabetes Mellitus? KRIS E.J. PARK, Emmanuel J. Favaloro, Keri D. Chambers, Steve C. Boyages, Jerry Koutts. Data from cross-sectional studies indicate that von Willibrand Factor (VWF), a marker of endothelial damage, is elevated in Type II diabetes mellitus (DM). Measurements of VWF have traditionally used quantitative protein assays, which yield no information concerning the quality of the VWF present. Thus, to date, it is not known whether the biological activity of VWF is increased in individuals with DM. The primary aim of this study is to quantify both the absolute level of VWF (using a standard VWF:Ag assay) and its biological activity (using a functional assay, VWF:CBA) in individuals with Type lI DM. The secondary aim is to examine if VWF levels or its activity is independently associated with presence of microvascular disease such as microalbuminuria. We studied 55 subjects (Age 50-75, mean 61.5 years, 29 males and 26 females) with Type II DM. Baseline characteristics are expressed in means 4-1 SD: duration of DM 7.14-6.0 years, total cholesterol (TC) 5.64-0.8 mmol/l, HDL 1.24-0.3 mmol/l, triglyceride (TG) 1.9-t-0.8 mmol/1, Apo B 1.14-0.2 g/l, HbAlc 7.54-1.6%, BSL 9.04-2.7 mmol/l and C-peptide 3.44-1.5 ug/1. The mean level of VWF:Ag was 1414-59% (Ref. Range 40-200%) and VWF:CBA was 1694-134% (Ref. Range 50-400%). Subjects with microalbuminuria (N=17) had higher level of VWF:Ag (1494-47 %) and VWF:CBA (1794-92%) than those with normoalbuminuria (N=38, 1374-63% and 1674-151% respectively), but the difference was not statistically significant. Furthermore, the preliminary data, using multivariate analysis, did not show correlation between lipid parameters or glycemic control to VWF:Ag or VWF:CBA levels, while C-peptide, duration of DM and presence of hypertension significantly correlated with elevated VWF:Ag levels and its activity. However, these levels were not independently predictive of microalbuminuria.
$293
In conclusion, VWF:Ag level and its biological activity was mildly elevated in people with Type II DM. In addition, this study does not support the hypothesis that increased levels or the activity of VWF are independently associated with the presence of microvascular disease in people with Type II DM. Finally, we recognise the limitation of the study due to small sample size and emphasize that these data are preliminary. This project is on going.
Pl192 Clinical Usefulness of Brain Natriuretic Peptide To Assess the Diabetic Cardiac Disorder H. HIMEI J, T. Matsuoka 2. / Okayama Health Foundation Hospital,
Okayama, Japan; 20kayama Red Cross General Hospital, Okayama, Japan Diabetic cardiac disorder tends to be insidious and the prediction for the asymptomatic myocardial infarction or sudden death which often complicate in patients with diabetic autonomic neuropathy is currently very difficult. Human brain natriuretic peptide(BNP) is secreted from the myocardium in response to ejection pressure during left ventricular systole, so it is generally considered to more specifically represent left ventricular function than human atrial natriuretic peptide (ANP). BNP level were measured and compared between 744 diabetic patients and 161 healthy individuals using an immunoradiometric assay method. In patients with abnormal BNP values, myocardial scintigaraphy and coronary angiography were performed in addition to electrocardiography and the results were compared. In most of the normal adults, the BNP level was within the normal range, with a mean level of 8.7 4- 4.5 pg/ml. A greater percentage of the diabetic patients had high blood BNP levels of 20 pg/ml or more. And when a blood BNP level of 20 pg/ml or more was defined as abnormal, BNP was useful for predicting cardiac disorder with a sensitivity of 95.7%, a specificity of 70.0%. Therefore, determination of BNP is a simple method of screening diabetic patients for cardiac disorder. These findings suggest that measurement of the blood BNP level is a useful method of screening in patients with diabetic myocardial dysfunction.
Pl193 Coronary Levels of Endothelin I and Angiotensin II and lntraluminal Coronary Diameters of Diabetics with Coronary Disease JORGE MUNDO. Diabetics are at increased risk of developing coronary disease. The incidence in diabetics is increased two to fourfold. The causes of angiopathy in diabetics are relatively unknown. Endothelin I (EI) and Angiotensin II (AII) are potent vascontrictor peptides that also have mitogenic activity on cultured vascular smooth muscle cells. The peptides may be involved in the modification of vascular structures and are likely candidates in the mediation for development of coronary disease. This study was done to determine if diabetic patients have increased levels in coronary circulation of EI and AII and altered intraluminal diameters compatible with their increased incidence of coronary disease. Also to determine if there is correlation between the peptides levels and the coronary calibers. Eight diabetics with coronary disease were catheterized and determined levels of AII and EI in the coronary sinus and aorta. Calibers of their Right Coronary Artery (RCA) and Left Anterior Descending Artery (LADA) were analyzed using a quantitative method. Levels of AII in coronary sinus and aorta (46 4- 18 and 35 4- 15 pg/ml, respectively) these values higher when compared to normal individuals (10 pg/ml, p <0.001). Levels of EI in coronary sinus and aorta (14 4- and 13 4- 6 pg/ml, respectively), these values higher compared to normal individuals (3 pg/ml p<0.001). RCA calibers in diabetics vs normal (3.01 mm vs 3.909 mm, respectively, p<0.0001). LADA calibers in diabetics vs normal (3.43 mm vs. 4.61 mm respectively, p < 0.0001. Correlation between coronary caliber and peptide level was positive. The study suggests that angiopathy in diabetics
University of the West Indies, Mona, Jamaica Jamaica has one of the highest age-adjusted mortality rates from diabetes in Latin America and the Caribbean. Death is predominantly from cardiovascular disease yet the prevalence of ischaemic heart disease (IHD) and dyslipidaemia in Jamaican diabetics is not known. The objective of the study was to investigate the prevalence of IHD and dyslipidaemia in Jamaican diabetics. A retrospective analysis of the charts of 180 diabetics seen at 2 clinics run by the Diabetes Association of Jamaica was done. The mean age was 55.0 (12 -83) years. 68.3% were female. The mean systolic blood pressure (BP) was 139 (80 - 260); diastolic BP 82 (50 -130)mmHg and random glucose 12.5 (1.6 - 27.8) mmol/1. 72.7% had a glycosylated hemoglobin greater than 1% above the norm. 49.3% had hypertension. 2.4% had a past history of angina or IHD. 13% had angina. The electrocardiogram was abnormal in 58.1%. 10.7% had ST segment depression 2mm and more, 12.8% T wave inversion 2 mm and more. Other abnormalities included left axis deviation (2), old myocardial infarction (2), bifascicular block (1), left bundle branch block (1), premature ventricular contractions (2), atrial flutter (1), sinus tachycardia (6), poor R wave progression (9) and nonspecific S-T, T wave changes (16). 15.6% had left ventricular hypertropohy. Total cholesterol >6.2 was seen in 11.2%; increased low density lipoprotein cholesterol >3.4 in 74.4% and decreased high density lipoprotein cholesterol <0.9 mmol/1 in 8.6%. The triglyceride was >2.3 mmol/l in 9.4% and the TC/HDL-C ratio was >4.5 in 11 of 23 patients. A large number of a symptomatic Jamaican diabetics have significantly abnormal resting ECG's which required further evaluation. Dyslipidaemia is common in this high-risk population.
Pl191 Is the Activity of VWF Increased in ~ II Diabetes Mellitus? KRIS E.J. PARK, Emmanuel J. Favaloro, Keri D. Chambers, Steve C. Boyages, Jerry Koutts. Data from cross-sectional studies indicate that von Willibrand Factor (VWF), a marker of endothelial damage, is elevated in Type II diabetes mellitus (DM). Measurements of VWF have traditionally used quantitative protein assays, which yield no information concerning the quality of the VWF present. Thus, to date, it is not known whether the biological activity of VWF is increased in individuals with DM. The primary aim of this study is to quantify both the absolute level of VWF (using a standard VWF:Ag assay) and its biological activity (using a functional assay, VWF:CBA) in individuals with Type lI DM. The secondary aim is to examine if VWF levels or its activity is independently associated with presence of microvascular disease such as microalbuminuria. We studied 55 subjects (Age 50-75, mean 61.5 years, 29 males and 26 females) with Type II DM. Baseline characteristics are expressed in means 4-1 SD: duration of DM 7.14-6.0 years, total cholesterol (TC) 5.64-0.8 mmol/l, HDL 1.24-0.3 mmol/l, triglyceride (TG) 1.9-t-0.8 mmol/1, Apo B 1.14-0.2 g/l, HbAlc 7.54-1.6%, BSL 9.04-2.7 mmol/l and C-peptide 3.44-1.5 ug/1. The mean level of VWF:Ag was 1414-59% (Ref. Range 40-200%) and VWF:CBA was 1694-134% (Ref. Range 50-400%). Subjects with microalbuminuria (N=17) had higher level of VWF:Ag (1494-47 %) and VWF:CBA (1794-92%) than those with normoalbuminuria (N=38, 1374-63% and 1674-151% respectively), but the difference was not statistically significant. Furthermore, the preliminary data, using multivariate analysis, did not show correlation between lipid parameters or glycemic control to VWF:Ag or VWF:CBA levels, while C-peptide, duration of DM and presence of hypertension significantly correlated with elevated VWF:Ag levels and its activity. However, these levels were not independently predictive of microalbuminuria.
$293
In conclusion, VWF:Ag level and its biological activity was mildly elevated in people with Type II DM. In addition, this study does not support the hypothesis that increased levels or the activity of VWF are independently associated with the presence of microvascular disease in people with Type II DM. Finally, we recognise the limitation of the study due to small sample size and emphasize that these data are preliminary. This project is on going.
Pl192 Clinical Usefulness of Brain Natriuretic Peptide To Assess the Diabetic Cardiac Disorder H. HIMEI J, T. Matsuoka 2. / Okayama Health Foundation Hospital,
Okayama, Japan; 20kayama Red Cross General Hospital, Okayama, Japan Diabetic cardiac disorder tends to be insidious and the prediction for the asymptomatic myocardial infarction or sudden death which often complicate in patients with diabetic autonomic neuropathy is currently very difficult. Human brain natriuretic peptide(BNP) is secreted from the myocardium in response to ejection pressure during left ventricular systole, so it is generally considered to more specifically represent left ventricular function than human atrial natriuretic peptide (ANP). BNP level were measured and compared between 744 diabetic patients and 161 healthy individuals using an immunoradiometric assay method. In patients with abnormal BNP values, myocardial scintigaraphy and coronary angiography were performed in addition to electrocardiography and the results were compared. In most of the normal adults, the BNP level was within the normal range, with a mean level of 8.7 4- 4.5 pg/ml. A greater percentage of the diabetic patients had high blood BNP levels of 20 pg/ml or more. And when a blood BNP level of 20 pg/ml or more was defined as abnormal, BNP was useful for predicting cardiac disorder with a sensitivity of 95.7%, a specificity of 70.0%. Therefore, determination of BNP is a simple method of screening diabetic patients for cardiac disorder. These findings suggest that measurement of the blood BNP level is a useful method of screening in patients with diabetic myocardial dysfunction.
Pl193 Coronary Levels of Endothelin I and Angiotensin II and lntraluminal Coronary Diameters of Diabetics with Coronary Disease JORGE MUNDO. Diabetics are at increased risk of developing coronary disease. The incidence in diabetics is increased two to fourfold. The causes of angiopathy in diabetics are relatively unknown. Endothelin I (EI) and Angiotensin II (AII) are potent vascontrictor peptides that also have mitogenic activity on cultured vascular smooth muscle cells. The peptides may be involved in the modification of vascular structures and are likely candidates in the mediation for development of coronary disease. This study was done to determine if diabetic patients have increased levels in coronary circulation of EI and AII and altered intraluminal diameters compatible with their increased incidence of coronary disease. Also to determine if there is correlation between the peptides levels and the coronary calibers. Eight diabetics with coronary disease were catheterized and determined levels of AII and EI in the coronary sinus and aorta. Calibers of their Right Coronary Artery (RCA) and Left Anterior Descending Artery (LADA) were analyzed using a quantitative method. Levels of AII in coronary sinus and aorta (46 4- 18 and 35 4- 15 pg/ml, respectively) these values higher when compared to normal individuals (10 pg/ml, p <0.001). Levels of EI in coronary sinus and aorta (14 4- and 13 4- 6 pg/ml, respectively), these values higher compared to normal individuals (3 pg/ml p<0.001). RCA calibers in diabetics vs normal (3.01 mm vs 3.909 mm, respectively, p<0.0001). LADA calibers in diabetics vs normal (3.43 mm vs. 4.61 mm respectively, p < 0.0001. Correlation between coronary caliber and peptide level was positive. The study suggests that angiopathy in diabetics