Different Characteristics of Chronic heart failure (CHF) in elderly diabetics and non diabetics

Higher plasma concentrations of the N-terminal fragment of brain natriuretic peptide (NT-pro-BNP) andthe tumor necrosis factor-a (TNF-a) have been observed in patients affected by chronic heart failure(CHF). Recent clinical studies have tried to correlate the plasma levels of these biomarkers with severityof the disease. To evaluate the role of NT-pro-BNP, TNF-a and C-reactive protein (CRP) in a population ofgeriatric patients affected by CHF, and to assess their different plasma levels in diabetics and innormoglycemic patients, we enrolled 57 patients affected by CHF: 29 patients were diabetic and 28 werenormoglycemic. Clinical and echocardiographic examinations were performed in all patients, in order toevaluate the NYHA-class and the left ventricular ejection fraction (EF). All of them had been stabilizedwithmedical therapy from at least 3 weeks. Plasma NT-pro-BNP, TNF-aand CRP levels weremeasured ineach recruited patient. In the whole population we observed a linear correlation between NT-pro-BNPlevels, EF and NYHA-class (p < 0.05) but there was no significant correlation between TNF-a or CRP andthe clinical or echocardiographic data (p = 0.588 and p = 0.9, respectively). Finally we evaluated, if therewere significant differences in the biomarker concentrations between diabetics and normoglycemics.Both the clinical and the echocardiographic parameters of systolic dysfunction were comparable in thesetwo groups. We observed a significant difference in CRP levels between the two groups (3.76 2.85 indiabetics vs. 1.42 2.35 in normoglycemics; p < 0.001). The NT-pro-BNP levels were also higher in diabeticsthan in normoglycemic patients (12867.8 18042.0 vs. 6400.89 5655.0; p = 0.07). Plasma TNF-a levels(23.03 11.52 vs. 23.31 12.0; p = 0.93) and left ventricular EF (35.65 4.03 vs. 35.18 3.55; p = 0.63)were similar in the two groups. In agreement with recent studies, we confirm a linear correlation betweenNT-pro-BNP, EF and the severity of disease in CHF patients. We also observed a greater cytokine activation indiabetics than in normoglycemic patients, demonstrating probably that in this group a greater inflammatoryreaction is present. 2009 Elsevier Ireland Ltd. All rights reserved.