Abstract
BackgroundCardiac-specific troponin detected with the new high-sensitivity assays can be chronically elevated in response to cardiovascular comorbidities and confer important prognostic information, in the absence of unstable coronary syndromes. Both diabetes mellitus and coronary artery disease are known predictors of troponin elevation. It is not known whether diabetic patients with coronary artery disease have different levels of troponin compared with diabetic patients with normal coronary arteries. To investigate this question, we determined the concentrations of a level 1 troponin assay in two groups of diabetic patients: those with multivessel coronary artery disease and those with angiographically normal coronary arteries.MethodsWe studied 95 diabetic patients and compared troponin in serum samples from 50 patients with coronary artery disease (mean age = 63.7, 58 % male) with 45 controls with angiographically normal coronary arteries. Brain natriuretic peptide and the oxidative stress biomarkers myeloperoxidase, nitrotyrosine and oxidized LDL were also determined.ResultsDiabetic patients with coronary artery disease had higher levels of troponin than did controls (median values, 12.0 pg/mL (95 % CI:10–16) vs 7.0 pg/mL (95 % CI: 5.9-8.5), respectively; p = 0.0001). The area under the ROC curve for the diagnosis of CAD was 0.712 with a sensitivity of 70 % and a specificity of 66 %. Plasma BNP levels and oxidative stress variables (myeloperoxidase, nitrotyrosine, and oxidized LDL) were not different between the two groups. In a multivariate analysis, gender (p = 0.04), serum glucose (0.03) and Troponin I (p = 0.01) had independent statistical significance.ConclusionTroponin elevation is related to the presence of chronic coronary artery disease in diabetic patients with multiple associated cardiovascular risk factors. Troponin may serve as a biomarker in this high-risk population.Trial registrationhttp://www.controlled-trials.com Registration number:ISRCTN26970041
Highlights
Cardiac-specific troponin detected with the new high-sensitivity assays can be chronically elevated in response to cardiovascular comorbidities and confer important prognostic information, in the absence of unstable coronary syndromes
Study subjects The study included patients with type 2 diabetes mellitus with angiographically documented proximal multivessel coronary stenosis of >70 %, these patients had normal ventricular function and received optimal medical treatment without coronary revascularization. This group of patients with multivessel coronary artery disease (CAD) was compared to patients with type 2 diabetes mellitus and angiographically normal coronary arteries identified by angiogram or coronary tomography, with normal ventricular function
We found that concentrations of Cardiac-specific troponins (cTn) were significantly higher (p = 0.0001) in diabetic patients with stable coronary artery disease
Summary
Cardiac-specific troponin detected with the new high-sensitivity assays can be chronically elevated in response to cardiovascular comorbidities and confer important prognostic information, in the absence of unstable coronary syndromes. Both diabetes mellitus and coronary artery disease are known predictors of troponin elevation. Segre et al BMC Cardiovascular Disorders (2015) 15:72 abnormalities [16], endothelial dysfunction [17] and higher levels of oxidative stress [18] Consistent with these functional alterations, the presence of type 2 diabetes mellitus was already a known predictor of elevated cardiac troponin in the general population with the older assays [19]. These elevations are related to cardiovascular disease and cardiovascular death in diabetic compared to nondiabetic patients [21]
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