Heart Failure in Diabetes: Natriuretic Peptides in Focus

Diabetes mellitus is an independent predictor for the development of heart failure. Arterial hypertension, coronary artery disease and diabetic cardiomyopathy are key elements for its occurrence. Left ventricular hypertrophy also contributes to an increased risk of heart failure in patients with diabetes. The poor prognosis in diabetic patients with heart failure emphasizes the need for specific and elaborate treatment strategies. Besides ECGs, echocardiographic assessments and X-ray investigations, screening with the natriuretic peptides NT-proBNP and BNP is of growing importance. Their analysis is also recommended in the European Society of Cardiology's guidelines on heart failure. Low serum concentrations of natriuretic peptides are associated with a high negative predictive value, and exclude cardiac dysfunction to a large extent. An increase in serum concentrations of natriuretic peptides is highly predictive of a left ventricular dysfunction. In diabetic patients with an acute coronary syndrome, NT-proBNP has been reported to be an independent risk factor for the prognosis. The assessment of natriuretic peptides in patients with cardiovascular disease at discharge may be highly suitable for the identification of high-risk patients. Depending on the underlying disease, treatment with diuretics, ACE inhibitors, .AT(1)-receptor antagonists and beta blockers present therapeutic options, which need to be accompanied by an optimization of blood glucose control.