Abstract
As the use of thiazolidinedione (TZD) becomes more popular, there is a growing concern that fluid retention associated with TZD use may precipitate or induce heart failure in patients with diabetes mellitus. Diabetes mellitus is an independent risk factor of heart failure; more attention must be given to this issue so that the outcome for this group of CAD equivalent patients can be improved. Traditionally echocardiography with dopplar ultrasound is the gold standard for the diagnosis of heart failure. However, the cost and technical cumbersome preclude it from being a full-scale screening tool. Plasma brain natriuretic peptide (BNP) level is closely correlated with both diastolic and systolic cardiac function, however the use of BNP for screening of cardiac dysfunction should be restricted to certain high-risk group. For diabetic patients with TZD associated edema the high negative predictive value of BNP may be useful for identifying patients who need further diagnostic evaluation. For diabetic patients with microalbuminuria and elevated BNP level prior to TZD administration, the risk of heart failure is higher than those without microalbuminuria. For this particular group of patients echocardiographic study should include a complete evaluation of diastolic dysfunction.