Abstract
IntroductionHigh-sensitivity cardiac troponin I(hs-TnI) and T levels(hs-TnT) are sensitive biomarkers of cardiomyocyte turnover or necrosis. Prior studies of the predictive role of hs-TnT in type 2 diabetes mellitus(T2DM) patients have yielded conflicting results. This study aimed to determine whether hs-TnI, which is detectable in a higher proportion of normal subjects than hsTnT, is associated with a major adverse cardiovascular event(MACE) in T2DM patients.Methods and resultsWe compared hs-TnI level in stored serum samples from 276 consecutive patients (mean age 65 ± 10 years; 57% male) with T2DM with that of 115 age-and sex-matched controls. All T2DM patients were prospectively followed up for at least 4 years for incidence of MACE including heart failure(HF), myocardial infarction(MI) and cardiovascular mortality. At baseline, 274(99%) patients with T2DM had detectable hs-TnI, and 57(21%) had elevated hs-TnI (male: 8.5 ng/L, female: 7.6 ng/L, above the 99th percentile in healthy controls). A total of 43 MACE occurred: HF(n = 18), MI(n = 11) and cardiovascular mortality(n = 14). Kaplan-Meier analysis showed that an elevated hs-TnI was associated with MACE, HF, MI and cardiovascular mortality. Although multivariate analysis revealed that an elevated hs-TnI independently predicted MACE, it had limited sensitivity(62.7%) and positive predictive value(38.5%). Contrary to this, a normal hs-TnI level had an excellent negative predictive value(92.2%) for future MACE in patients with T2DM.ConclusionThe present study demonstrates that elevated hs-TnI in patients with T2DM is associated with increased MACE, HF, MI and cardiovascular mortality. Importantly, a normal hs-TnI level has an excellent negative predictive value for future adverse cardiovascular events during long-term follow-up.
Highlights
High-sensitivity cardiac troponin I(hs-TnI) and T levels(hs-TnT) are sensitive biomarkers of cardiomyocyte turnover or necrosis
The present study demonstrates that elevated hs-TnI in patients with type 2 diabetes mellitus (T2DM) is associated with increased major adverse cardiovascular event (MACE), HF, myocardial infarction (MI) and cardiovascular mortality
It has been proposed that chronic hyperglycemia contributes to subtle myocardial injury as detected by High-sensitivity cardiac troponin levels T (hs-TnT) that is beyond its effects on development of clinical atherosclerotic coronary disease [13]
Summary
High-sensitivity cardiac troponin I(hs-TnI) and T levels(hs-TnT) are sensitive biomarkers of cardiomyocyte turnover or necrosis. This study aimed to determine whether hs-TnI, which is detectable in a higher proportion of normal subjects than hsTnT, is associated with a major adverse cardiovascular event(MACE) in T2DM patients. High-sensitivity cardiac troponin levels T (hs-TnT) and I (hs-TnI) are more sensitive biomarkers that can detect troponin below the clinical threshold, and reflect subtle cardiomyocyte turnover or Recent studies have demonstrated that patients with type 2 diabetes mellitus (T2DM) without prior cardiovascular disease [12] and a high hbA1c% had elevated hs-TnT [13]. This study sought to investigate whether an elevated hs-TnI is associated with a major adverse cardiovascular event (MACE) in patients with T2DM
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