Determinants and prognostic implications of Cardiac Troponin T measured by a sensitive assay in Type 2 Diabetes Mellitus

Abstract

BackgroundThe cardiac troponins are biomarkers used for diagnosis of myocardial injury. They are also powerful prognostic markers in many diseases and settings. Recently introduced high-sensitivity assays indicate that chronic cardiac troponin elevations are common in response to cardiovascular (CV) morbidity. Type 2 diabetes mellitus (T2DM) confers a high risk of CV disease, but little is known about chronic cardiac troponin elevations in diabetic subjects. Accordingly, we aimed to understand the prevalence, determinants, and prognostic implications of cardiac troponin T (cTnT) elevations measured with a high-sensitivity assay in patients with T2DM.MethodscTnT was measured in stored, frozen serum samples from 124 subjects enrolled in the Asker and Bærum Cardiovascular Diabetes trial at baseline and at 2-year follow-up, if availabe (96 samples available). Results were analyzed in relation to baseline variables, hospitalizations, and group assignment (multifactorial intensive versus conventional diabetes care for lowering CV risk).ResultsOne-hundred thirteen (90 %) had detectable cTnT at baseline and of those, 22 (18 % of the total population) subjects had values above the 99th percentile for healthy controls (13.5 ng/L). Levels at baseline were associated with conventional CV risk factors (age, renal function, gender). There was a strong correlation between cTnT levels at the two time-points (r = 0.92, p > 0.001). Risk for hospitalizations during follow-up increased step-wise by quartiles of hscTnT measured at baseline (p = 0.058).ConclusionsElevations of cTnT above the 99th percentile measured by a highly sensitive assay were encountered frequently in a population of T2DM patients. cTnT levels appeared to be stable over time and associated with conventional CV risk factors. Although a clear trend was present, no statistically robust associations with adverse outcomes could be found.

High-sensitive troponin T is associated with all-cause and cardiovascular mortality in stable outpatients with type 2 diabetes (ZODIAC-37)

“…The percentage of patients with raised levels of hs-cTnT was comparable to other studies conducted in patients with T2D and higher than in studies conducted in the general population (9, 11,19,20). A relation between low detectable hs-cTnT levels and mortality has previously been established in women with T2D after 12 years of follow-up.…”

“…Lastly, hs-cTnT was only measured once at baseline so it was not possible to adjust for fluctuations in hscTnT concentrations. Though, Norwegian researchers found a strong correlation between hscTnT levels at baseline and after 2 years follow-up (19).…”

Serial Measurement of Cardiac Troponin T Using a Highly Sensitive Assay in Patients With Chronic Heart Failure

“…Increases in hs-cTnT concentrations were associated with all-cause mortality (incidence rates, 8.19 [7.51-8.88 Key Words: biomarkers Ⅲ heart failure Ⅲ natriuretic peptides Ⅲ prognosis Ⅲ troponin T V ery low circulating levels of troponin are detectable in the general population with the new generation of highly sensitive assays and are associated with adverse cardiovascular outcomes. [1][2][3] Besides acute myocardial infarction, elevated troponin levels are also reported in several chronic disease states like coronary artery disease, 4,5 diabetes mellitus, 6 or chronic kidney disease. 7 Troponin release in the bloodstream is low in patients with stable chronic heart failure (HF) and predicts adverse outcomes.…”

Effect of treatment with rosiglitazone on high-sensitivity cardiac troponin levels among patients with type 2 diabetes mellitus

“…10,11,13 Furthermore, the proportion of patients with hscTnT levels above the 99th percentile cut-off for MI was also notably high in this study, of clinical importance as this could confound diagnosis of MI in up to onequarter of such patients if the hscTnT assay is used. 14,15 TZDs have been associated with adverse outcomes such as an increased risk of new or worsening peripheral oedema with incidence ranging 2.5%-16.3% and based on published meta-analysis, 1.3-to 2.2-fold increased risk of incident HF with pioglitazone and rosiglitazone, respectively. 1,[16][17][18][19][20] Furthermore, evidence from at least one animal model suggests accelerated apoptosis and cardiac toxicity with rosiglitazone, proposed to be mediated by reactive oxygen species.…”