Role of Resistin, IL-6 and NH2-Terminal Portion Probnp in The
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Cardiovascular and metabolic risk BMJ Open Diab Res Care: first published as 10.1136/bmjdrc-2020-001206 on 28 September 2020. Downloaded from Open access Original research Role of resistin, IL-6 and NH2- terminal portion proBNP in the pathogenesis of cardiac disease in type 2 diabetes mellitus Samar Ebrahim Ghanem,1 Mohamed Abdel- Samiee ,2 Mohamed Hamdy Torky,3 Ahmed Gaafar,4 Somia Mokabel Mohamed,5 Ghada Mohamed Mohamed Salah Eldin,5 Samah Mohammed Awad,6 Karema A Diab,7 Dalia M ELsabaawy,8 Sania Ali Yehia,9 Hany Abdelbary Abdelaziz Elbasyouni,10 Amr Aly Elshormilisy11 To cite: Ghanem SE, ABSTRACT Abdel- Samiee M, Torky MH, Introduction Epidemiological and genetic studies have Significance of this study et al. Role of resistin, IL-6 recorded the association between proinflammatory cytokines and NH2-terminal portion and the development of insulin resistance, diabetes, and What is already known about this subject? proBNP in the pathogenesis cardiovascular disease. The role of interleukin 6 (IL-6), NH2- ► Epidemiological and genetic studies have recorded of cardiac disease in the association between proinflammatory cytokines type 2 diabetes mellitus. terminal portion pro- brain natriuretic peptide (NT- proBNP) and resistin in the pathogenesis of heart disease in type 2 diabetes and the development of insulin resistance, diabetes, BMJ Open Diab Res Care and cardiovascular disease. 2020;8:e001206. doi:10.1136/ mellitus (T2DM) is still a matter of controversy. The current The role of interleukin 6 (IL-6), NH2-terminal por- bmjdrc-2020-001206 study aimed to evaluate the role of these biomarkers in the ► development of left ventricular systolic dysfunction and the tion pro- brain natriuretic peptide (NT- proBNP) and ability to use them as non- invasive test in the prediction of left resistin in the pathogenesis of heart disease in pa- Received 17 January 2020 ventricular hypertrophy and systolic dysfunction in T2DM. tients with type 2 diabetes mellitus is still a matter Revised 29 May 2020 Research design and methods 150 participants were of controversy. Accepted 4 August 2020 included in this case–control study. Patients were divided What are the new findings? into two subgroups according to echocardiographic findings: ► There was a significant increase in the level of re- group 1a included 46 patients with type 2 diabetes mellitus sistin, NT- proBNP and IL-6 in group 1a patients and echocardiographic evidence of abnormal systolic compared with group 1b and in healthy controls. function; group 1b included 54 patients with type 2 diabetes Echocardiographic parameters showed a significant mellitus and with normal echocardiogenic study; and group ► increase in left ventricular mass index, left ventri- 2 included 50 apparently healthy controls. Routine laboratory cle posterior wall thickness, interventricular septum investigations such as complete blood count, liver and renal thickness, and left ventricle mass in group 1a com- function tests, and lipid profile, serum IL-6, NT- proBNP, and pared with group 1b and the control group. http://drc.bmj.com/ resistin were measured in all participants. Conventional echocardiography was done with special concern on the How might these results change the focus of assessment of left ventricular systolic function (ejection research or clinical practice? fraction). ► Proinflammatory cytokines had a clear relation with Results There was a significant increase in the level of left ventricular systolic dysfunction and hypertrophy resistin, NT- proBNP and IL-6 in group 1a patients compared and can be used as early non-invasive markers for with group 1b and in healthy controls. Echocardiographic detection of left ventricular remodeling and systolic on October 2, 2021 by guest. Protected copyright. parameters showed a significant increase in left ventricular dysfunction in patients with type 2 diabetes mellitus. mass index, left ventricle posterior wall thickness, ► Resistin, NT- proBNP, IL-6 and echocardiographic interventricular septum thickness, and left ventricle mass in data and suggesting them as diagnostic markers are group 1a compared with group 1b and the control group. The a subject of great biomedical importance and con- increased left ventricular mass index was associated with tribute to knowledge. higher levels of IL-6, NT- proBNP and resistin. © Author(s) (or their Conclusions Proinflammatory cytokines had a clear relation employer(s)) 2020. Re- use permitted under CC BY-NC. No with left ventricular systolic dysfunction and hypertrophy and commercial re- use. See rights can be used as early non- invasive markers for detection of stroke, and peripheral vascular disease are the 1 and permissions. Published left ventricular remodeling and systolic dysfunction in patients main macrovascular complications of DM. by BMJ. with T2DM. Echocardiographic studies on large data- For numbered affiliations see bases of patients with diabetic heart failure end of article. INTRODUCTION have shown an association with left ventric- Correspondence to The American Heart Association designated ular hypertrophy (LVH), increased heart 2 Dr Mohamed Abdel- Samiee; diabetes mellitus (DM) as a major risk factor mass, and diastolic function. The effects of drmohammed100@ yahoo. com for cardiovascular disease (CVD). CVD, type 2 diabetes mellitus (T2DM) on the heart BMJ Open Diab Res Care 2020;8:e001206. doi:10.1136/bmjdrc-2020-001206 1 BMJ Open Diab Res Care: first published as 10.1136/bmjdrc-2020-001206 on 28 September 2020. Downloaded from Cardiovascular and metabolic risk can be broadly grouped into two main categories: coro- enrolled in the study as a control group (group 2). The nary heart disease (CHD) and diabetic cardiomyopathy source of the controls was dependent on the source of (DCM), which is characterized by LVH, left ventricular the cases, such as their family relatives. Through system- (LV) diastolic dysfunction, LV systolic dysfunction and atic random sampling, one out of five individuals from cardiac autonomic neuropathy.3 4 The common final the family relatives of the patients in group 1 was selected pathway for both CHD and DCM is clinical heart failure.5 as the control. Brain natriuretic peptide (BNP) is a potent vasodilator DM was diagnosed according to WHO and the American and a natriuretic factor regulating salt and water hemo- Diabetes Association as fasting blood glucose ≥126 mg/ stasis. It is stored in the human cardiac tissue mainly dL or 2- hour postprandial glucose (PG) ≥200 mg/dL.16 as BNP-32, with a lesser amount of the precursor pre- Inclusion criteria included adults aged more than 30 proBNP. The circulating plasma forms of BNP are BNP-32 years old and history of T2DM and on regular treatment. 6 and the NH2- terminal portion proBNP (NT-proBNP) . Exclusion criteria included pregnancy, acute coro- BNP and NT- proBNP may be used as a screening test nary syndrome, constrictive pericarditis, acute pericar- 7 for exercise- induced myocardial ischemia. In addition, ditis, hypertrophic cardiomyopathy, severe valvular heart plasma BNP in patients with systolic heart failure reflects disease, atrial fibrillation, history of chronic or acute 8 the severity of diastolic abnormality. The diagnosis of inflammatory disease in the preceding 3 months, malig- heart failure due to diastolic dysfunction is usually based nancies, autoimmune diseases, and type 1 DM. on typical symptoms and signs of heart failure in patients A written informed consent from all participants was 9 with preserved LV systolic function. taken. As vascular inflammation has emerged as an important All participants underwent the following: component of CVD, it is critical to elucidate the role of I. Full history taking and clinical examination. interleukin 6 (IL-6) in hypertension, endothelial dysfunc- 1. General examination: assessment of general con- tion,10 CHD and congestive heart failure with insulin resis- 11 dition and heart rate and blood pressure. tance in T2DM. IL-6 level increases in CVD, including 2. Cardiac examination for signs of heart failure, atherosclerosis, diabetes, heart failure, and hypertension. 12 cardiac murmurs or cardiomegaly; pulse exam- Its level is correlated positively with CVD progression. ination to detect peripheral vascular disease or Resistin is a 12.5 kD protein rich in cysteine and is 13 significant arrhythmia. produced mainly from activated white blood cells. It is 3. Anthropometric measures: measurement of a proinflammatory marker that is associated with insulin body weight in kilograms and height in meter, resistance, atherosclerosis and cardiac outcomes of DM.14 from which the body surface area (BSA) was cal- Resistin is produced and released from adipose tissue to 17 culated according to the formula of Dubois. serve endocrine functions likely involved in insulin resis- BSA(M2) = 0.007184 HEIGHT (CM)0.725 tance. This idea primarily stems from studies demon- – × × 0.425 strating that serum resistin levels increase with obesity WEIGHT (KG) and involved in energy metabolism and T2DM. Serum 4. Echocardiography. resistin levels have been found to decline with decreased The M- mode measurements obtained included the 15 following: adiposity following medical treatment. http://drc.bmj.com/ The purpose of our study was to identify the role of Two- dimensional guided M-mode measurements were these biomarkers in the development of LV systolic obtained at the left lateral position from the parasternal dysfunction and the ability to use them as a non-invasive long-axis view. Values were carefully