Distribution and prognostic value of high-sensitive troponin T measurement in patients with type 2 diabetes without cardiovascular disease

Bluro, Ignacio; Nardi, María Amelia; Miguel, Raúl De; Fernández, Martín Tejedor; Rolando, Jesica Y.; Fóscolo, Maria M. Abraham; Denaday, Lisandro R.; Candenas, Nereo; Cagide, Arturo; Pizarro, Rodolfo; Furci, Aida

doi:10.1016/j.endinu.2020.05.007

Cited by 2 publications

(1 citation statement)

References 26 publications

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“…In contrast, 99th percentiles of hs-cTnI irrespective of assays were very close across glycemic status and 95% CIs extensively overlapped. Similarly, Bluro et al found the 99th percentile of hs-cTnT (Roche) derived from type 2 diabetes patients with no cardiovascular, renal, inflammatory, or systemic disease was over threefold of the manufacturer-proposed value (48 vs. 14 ng/L) [ 27 ]. Whereas, Krintus et al found excluding individuals with HbA1c ≥ 6.5% from the presumably healthy population only had a marginal effect on the URL of Abbott hs-cTnI (11.1 vs. 11.2 ng/L, before and after exclusion) [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Distribution and prognostic value of high-sensitivity cardiac troponin T and I across glycemic status: a population-based study

Zhang,

Li,

Zhang

et al. 2024

Cardiovasc Diabetol

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Background Whether distributions and prognostic values of high-sensitivity cardiac troponin (hs-cTn) T and I are different across normoglycemic, prediabetic, and diabetic populations is unknown. Methods 10127 adult participants from the National Health and Nutrition Examination Survey 1999–2004 with determined glycemic status and measurement of at least one of hs-cTn assays were included, from whom healthy participants and presumably healthy diabetic and prediabetic participants were selected to investigate pure impacts of glycemic status on distributions of hs-cTn. The nonparametric method and bootstrapping were used to derive the 99th upper reference limits of hs-cTn and 95% CI. Participants with available follow-up and hs-cTn concentrations of all 4 assays were included in prognostic analyses. Associations of hs-cTn with all-cause and cardiac-specific mortality were modeled by Cox proportional hazard regression under the complex survey design. The incremental value of hs-cTn to an established risk score in predicting cardiac-specific mortality was assessed by the 10-year area under time-dependent receiver operating characteristic curve (AUC) using the Fine-Grey competing risk model. Results Among 9714 participants included in prognostic analyses, 5946 (61.2%) were normoglycemic, 2172 (22.4%) prediabetic, and 1596 (16.4%) diabetic. Hyperglycemic populations were older than the normoglycemic population but sex and race/ethnicity were similar. During the median follow-up of 16.8 years, hs-cTnT and hs-cTnI were independently associated with all-cause and cardiac-specific mortality across glycemic status. In the diabetic population, adjusted hazard ratios per 1-standard deviation increase of log-transformed hs-cTnT and hs-cTnI (Abbott) concentrations were 1.77 (95% CI 1.48–2.12; P < .001) and 1.83 (95% CI 1.33–2.53; P < .001), respectively, regarding cardiac-specific mortality. In the diabetic but not the normoglycemic population, adding either hs-cTnT (difference in AUC: 0.062; 95% CI 0.038–0.086; P < 0.001) or hs-cTnI (Abbott) (difference in AUC: 0.071; 95% CI 0.046–0.097; P < 0.001) would significantly increase the discriminative ability of the risk score; AUC of the score combined with hs-cTnT would be further improved by incorporating hs-cTnI (0.018; 95%CI 0.006–0.029; P = 0.002). The 99th percentile of hs-cTnT of the presumably healthy diabetic population was higher than the healthy population and had no overlap in 95% CIs, however, for hs-cTnI 99th percentiles of the two populations were very close and 95% CIs extensively overlapped. Conclusions Hs-cTnT and hs-cTnI demonstrated consistent prognostic associations across glycemic status but incremental predictive values in hyperglycemic populations only. The susceptibility of hs-cTnT 99th percentiles to diabetes plus the additive value of hs-cTnI to hs-cTnT in diabetic cardiovascular risk stratification suggested hs-cTnI and hs-cTnT may be differentially associated with glycemic status, but further research is needed to illustrate the interaction between hyperglycemia and hs-cTn.

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Section: Discussionmentioning

confidence: 99%

Distribution and prognostic value of high-sensitivity cardiac troponin T and I across glycemic status: a population-based study

Zhang,

Li,

Zhang

et al. 2024

Cardiovasc Diabetol

View full text Add to dashboard Cite

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Prognostic value of high-sensitivity cardiac troponin for major adverse cardiovascular events in patients with diabetes: a systematic review and meta-analysis

Song,

Lan,

et al. 2023

PeerJ

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Background High-sensitivity cardiac troponin (hs-cTn) is associated with cardiovascular outcomes in the general population, but the prognostic value of hs-cTn in the diabetic population remains inconclusive. This study aimed to systematically review current evidence regarding the association between hs-cTn and the prognosis of diabetic patients. Methods MEDLINE, Embase, and the Cochrane Database were searched from inception to May, 2023. Observational studies that investigated the prognostic value of hs-cTn in diabetic patients were included in this meta-analysis. Studies were excluded if they did not report outcomes of interest, or urine hs-cTn were measured. Two independent investigators extracted and analyzed the data according to the PRISMA guidelines. The primary outcome was long-term major adverse cardiovascular events (MACE). Results We included 30 cohort studies of 62,419 diabetic patients. After a median follow-up of 5 (4.1–9.5) years, the pooled results suggested elevation of hs-cTn was associated with a significantly increased risk of MACE (adjusted hazard ratio (HR) per standard deviation (SD) change 1.15, 95% CI [1.06–1.25], I2 = 0%) and heart failure (adjusted HR per SD change 1.33, 95% CI [1.08–1.63], I2 = 0%) in patients with diabetes. No significant association was found regarding the association between elevation of hs-cTn and risk of all-cause mortality (adjusted HR per SD change 1.24, 95% CI [0.98–1.57], I2 = 0%). The results of sensitivity analyses were similar in prospective cohort studies, high-quality studies, or population without major cardiovascular comorbidities at baseline. hs-cTn may represent a strong and independent predictor of MACE and heart failure in diabetic patients. Future research is warranted to determine the appropriate cutoff value for hs-cTn with different comorbidities, for instance, diabetic nephropathy, peripheral artery diseases, etc.

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Distribution and prognostic value of high-sensitive troponin T measurement in patients with type 2 diabetes without cardiovascular disease

Cited by 2 publications

References 26 publications

Distribution and prognostic value of high-sensitivity cardiac troponin T and I across glycemic status: a population-based study

Distribution and prognostic value of high-sensitivity cardiac troponin T and I across glycemic status: a population-based study

Prognostic value of high-sensitivity cardiac troponin for major adverse cardiovascular events in patients with diabetes: a systematic review and meta-analysis

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