AimTo create and validate a prediction model to identify patients with type 2 diabetes (T2D) at high risk of new‐onset heart failure (HF), including those treated with a sodium‐glucose cotransporter‐2 (SGLT2) inhibitor.MethodsA prediction model was developed from the Aliskiren Trial in Type 2 Diabetes Using Cardiorenal Endpoints (ALTITUDE), a trial in T2D patients with albuminuria or cardiovascular disease. We included 5081 patients with baseline N‐terminal pro B‐type natriuretic peptide (NT‐proBNP) measurement and no history of HF. The model was developed using Cox regression and validated externally in the placebo arm of the Canagliflozin Cardiovascular Assessment Study (CANVAS), which included 996 participants with T2D and established cardiovascular disease or high cardiovascular risk, and in patients treated with canagliflozin.ResultsALTITUDE participants (mean age 64 ± 9.8 years) had a median serum NT‐proBNP level of 157 (25th–75th percentile 70–359) pg/mL. Higher NT‐proBNP level, troponin T (TnT) level and body mass index (BMI) emerged as significant and independent predictors of new‐onset HF in both cohorts. The model further contained urinary albumin‐to‐creatinine ratio, glycated haemoglobin, age, haematocrit, and use of calcium channel blockers. A prediction model including these variables had a C‐statistic of 0.828 (95% confidence interval [CI] 0.801–0.855) in ALTITUDE and 0.800 (95% CI 0.720–0.880) in CANVAS. The C‐statistic of this model increased to 0.847 (95% CI 0.792–0.902) in patients after 1 year of canagliflozin treatment.ConclusionIn patients with T2D, higher NT‐proBNP level, TnT level and BMI are independent and externally validated predictors of new‐onset HF, including patients using an SGLT2 inhibitor. This newly developed model may identify patients at high risk of new‐onset HF, contributing to early recognition and possibly prevention.

中文翻译：

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根据 ALTITUDE 和 CANVAS 预测 2 型糖尿病患者新发心力衰竭

目的 创建并验证预测模型，以识别新发心力衰竭 (HF) 高风险的 2 型糖尿病 (T2D) 患者，包括接受钠-葡萄糖协同转运蛋白 2 (SGLT2) 抑制剂治疗的患者。该药物源自使用心肾终点的 2 型糖尿病阿利吉仑试验 (ALTITUDE)，这是一项针对患有蛋白尿或心血管疾病的 2 型糖尿病患者的试验。我们纳入了 5081 名基线 N 末端 B 型利钠肽原 (NT-proBNP) 测量且无心力衰竭病史的患者。该模型是使用 Cox 回归开发的，并在 Canagliflozin 心血管评估研究 (CANVAS) 的安慰剂组中进行了外部验证，该研究包括 996 名患有 T2D 且已确诊心血管疾病或高心血管风险的参与者，以及接受 Canagliflozin 治疗的患者。结果 ALTITUDE 参与者（平均年龄 64 ± 9.8 岁）的中位血清 NT-proBNP 水平为 157（第 25-75 个百分位数 70-359）pg/mL。在这两个队列中，较高的 NT-proBNP 水平、肌钙蛋白 T (TnT) 水平和体重指数 (BMI) 是新发心力衰竭的重要且独立的预测因素。该模型还包含尿白蛋白与肌酐的比率、糖化血红蛋白、年龄、血细胞比容和钙通道阻滞剂的使用。包含这些变量的预测模型在 ALTITUDE 中的 C 统计量为 0.828（95% 置信区间 [CI] 0.801–0.855），在 CANVAS 中的 C 统计量为 0.800（95% CI 0.720–0.880）。在接受卡格列净治疗 1 年后，该模型的 C 统计量增加至 0.847（95% CI 0.792-0.902）。结论在 T2D 患者中，较高的 NT-proBNP 水平、TnT 水平和 BMI 是独立且经过外部验证的新的预测因素。 ‐发作性心力衰竭，包括使用 SGLT2 抑制剂的患者。这种新开发的模型可以识别新发心力衰竭高风险的患者，有助于早期识别和可能的预防。