Clinical significance of brain natriuretic peptide and N-terminal pro-brain natriuretic peptide monitoring in type 2 diabetes mellitus

Brain natriuretic peptide (BNP) and N-terminal pro-brain natriuretic peptide (NT-proBNP) are polypeptide hormones released by cardiomyocytes in response to cardiac volume or pressure overload. The results of numerous studies have demonstrated the importance of these biomarkers for the diagnosis of chronic heart failure (CHF), including studies in patients with type 2 diabetes mellitus (T2DM). It has also been shown that the elevated BNP/NT-proBNP levels are associated with an unfavorable prognosis, and a decrease in the level of biomarkers over time can lead to a reduced incidence of fatal and non-fatal cardiovascular outcomes, as well as death from any cause. To date, the threshold values of BNP/NT-proBNP for the diagnosis of CHF, especially the phenotype of CHF with preserved left ventricular ejection fraction (CHFpEF), remain a subject of discussion, since the level of these biomarkers can be influenced by age, body mass index (BMI), kidney function, insulin resistance, acute and chronic inflammation. The aim of this review is to summarize the existing data on the clinical significance of BNP/ NT-proBNP monitoring with a focus on patients with T2DM and on factors that may influence the concentration of these biomarkers in the blood. The use of individual BNP/NT-proBNP cut-off values to improve the diagnostic accuracy of both asymptomatic cardiac dysfunction and overt CHF represents a promising area for further research.

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