Purpose .– Epidemiological studies show a strong correlation between diabetes mellitus (DM) and heart failure. DM may result in cardiac and structural abnormalities (diabetic cardiomyopathy) before symptoms onset. The diagnosis of left ventricular (LV) dysfunction at this stage could offer the possibility of an early therapy to stop the progression to overt heart failure. The aim of the study was to verify whether BNP might detect preclinical diastolic dysfunction (LVDD) in type 2 diabetic patients.

Methods .– We enrolled 142 consecutive ambulatory patients (69 males and 73 female, age 35–65 years) with type 2 DM and without history of coronary artery disease. All patients underwent clinical evaluation, laboratory assessment of brain natriuretic peptide (BNP) and echocardiographic examination for detection of systolic (ejection fraction ≤ 40%) or diastolic dysfunction and LV hypertrophy (LV mass > 50 g/m2.7).

Results .– No patients showed systolic impairment of left ventricular function, whereas diastolic dysfunction was detected in 64 (45%) cases (all impaired relaxation). Median BNP was 30 pg/mL without any significant difference between 78 patients with normal left ventricular function and 64 with diastolic dysfunction; in 60 (43%) patients showing HbA _1c greater than or equal to 8 (uncontrolled diabetes), normal function was found in 36 and diastolic dysfunction in 24, with a significant difference of BNP at multivariate analysis (OR = 1.03, 95%CI = 1.04–1.09, P = 0.002). In uncontrolled diabetic cohort, BNP was a strong predictor for LVDD (OR = 3.1, 95%CI = 1.5–6.1, P = 0.004) along with the duration of diabetes (OR = 2.1, 95%CI = 1.3–3.2, P = 0.034). BNP > 25pg/mL was a cut-off value with high accuracy to detect a LVDD.

Conclusions .– BNP could be a cheap, easy and useful tool to screen patients with preclinical ventricular diastolic dysfunction among those particularly prone to develop cardiovascular complications, such as uncontrolled diabetic patients.