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]

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Summary

Introduction

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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