High-Sensitivity Cardiac Troponin T for Early Prediction of Evolving Non–ST-Segment Elevation Myocardial Infarction in Patients with Suspected Acute Coronary Syndrome and Negative Troponin Results on Admission

BackgroundSubclinical myocardial injury, as measured by high‐sensitivity cardiac troponin T (hsTnT), and myocardial stress, as measured by N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP), are related to glycemic control in patients with type 2 diabetes mellitus, and are strong predictors of adverse cardiovascular outcomes. We sought to determine whether antihyperglycemic therapy improves measures of myocardial injury and myocardial stress in patients with type 2 diabetes mellitus.Methods and ResultsWe randomized, in a 2×2 factorial fashion, 438 patients with type 2 diabetes mellitus to insulin glargine, metformin, the combination, or placebo and measured changes in NT‐proBNP and hsTnT after 12 weeks of therapy. At baseline, the median (Q1–Q3) plasma concentration was 35.4 (15.7–86.3) ng/L for NT‐proBNP and 6.7 (4.6–10.1) ng/L for hsTnT. The adjusted (95% confidence interval) change in NT‐proBNP concentration was 20.7% (7.9–35.0) in the insulin arm compared with 0.13% (−10.8 to 12.5) in the no‐insulin arm (P=0.03 for comparison). These changes were not related to changes in fasting or postprandial glucose, glycated hemoglobin, weight, blood pressure, or inflammation. In the metformin arm, the adjusted change in NT‐proBNP was 7.8% (−3.7 to 20.7) compared with 13.0% (0.72–26.8) in the no‐metformin arm (P=0.58). No significant changes in hsTnT concentrations were observed for any of the treatment arms.ConclusionsInsulin glargine was associated with a significant 20.7% increase in NT‐proBNP, a marker of myocardial stress, after 12 weeks of therapy. No change in hsTnT, a marker of myocardial injury, was observed. The changes were independent of substantial improvements in glucose control.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT00366301.

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“…The 10% coefficient of variation is less than this value 21, 22. In total, 93.2% of participants had hsTnT ≥3 ng/L.…”

Section: Methodsmentioning

confidence: 85%

Randomized Trial of the Effects of Insulin and Metformin on Myocardial Injury and Stress in Diabetes Mellitus: A Post Hoc Exploratory Analysis

Srivastava

Pradhan

Cook

et al. 2017

JAHA

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“…Several factors affect hs-cTnT concentrations including extracellular volume [13], cardiac rhythm [14], myocardial ischaemia [15], and the dialysis prescription [16,17]. These influences were assessed using a structured clinical interview, physical examination and medical records review to ascertain interim hospitalisation, changes to medication and/or the dialysis prescription.…”

Section: Patient Assessmentmentioning

confidence: 99%

Biological variation of high sensitivity cardiac troponin-T in stable dialysis patients: implications for clinical practice

Fahim

Hayen

Horvath

et al. 2016

Clinical Chemistry and Laboratory Medicine (CCLM)

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“…Overall, these findings supported the use of troponin as the biomarker of choice in risk stratification, and NACB advocated and recommended its measurement in all patients with suspected ACS. A troponin concentration above the 99th percentile is an indicator of death and an increased risk of recurrent ischemic events (Giannitsis et al, 2010). Cardiac troponin is the preferred marker for myocardial injury in the new guidelines for the diagnosis and treatment of non-STsegment elevation ACS (Apple et al, 2007).…”

Section: Discussionmentioning

confidence: 99%

“…The role of high-sensitivity cTnT (hs-cTnT) in myocardial ischemia has been demonstrated in many studies; hs-cTnT has recently become commercially available (Laufer et al, 2010) and is being produced and distributed by Roche for clinical applications. One report showed that even mild coronary artery disease was associated with quantifiable circulating levels of hs-cTnT in patients without acute coronary syndrome (ACS) (Laufer et al, 2010), whereas other research revealed its function in the prediction of evolving non-ST-segment elevation myocardial infarction among patients with suspected ACS and negative troponin on admission (Giannitsis et al, 2010). However, there is insufficient evidence to support the diagnostic sensitivity and specificity of cTnT for the detection of myocardial ischemia.…”

Section: Introductionmentioning

confidence: 99%

High-sensitivity cardiac troponin T is a predictor of recurrent acute coronary syndrome in patients with acute myocardial infarction

Sheng

Kang

et al. 2014

Genet. Mol. Res.

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ABSTRACT. High-sensitivity cardiac troponin T is a useful tool for diagnosing myocardial ischemia. However, its role in the prognosis of patients with acute myocardial infarction has not been studied. Here, the prognostic value of high-sensitivity cardiac troponin T for patients with acute myocardial infarction was investigated. The concentrations of high-sensitivity cardiac troponin T, other clinical chemistry makers, and living habits were investigated at the time of admission in patients with acute coronary syndrome, whereas the high-sensitivity cardiac troponin T concentrations at 6 h after admission and during recovery were analyzed in other patient groups. The concentration of high-sensitivity cardiac troponin T was significantly higher in patients with acute myocardial infarction than in those with other cardiac diseases and in controls (P < 0.01). Based on the standard diagnostic criterion, 134 patients were diagnosed with acute myocardial infarction. Monitoring the change in concentration of high-sensitivity cardiac troponin T in patients with acute coronary syndrome can reduce the risk of recurrence and death.

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High-Sensitivity Cardiac Troponin T for Early Prediction of Evolving Non–ST-Segment Elevation Myocardial Infarction in Patients with Suspected Acute Coronary Syndrome and Negative Troponin Results on Admission

Abstract: BACKGROUND:We sought to determine the diagnostic performance of the new high-sensitivity cardiac troponin T (hs-cTnT) assay for early detection of non-STsegment myocardial infarction (NSTEMI) in patients with acute coronary syndrome.

Cited by 310 publications

References 20 publications

Randomized Trial of the Effects of Insulin and Metformin on Myocardial Injury and Stress in Diabetes Mellitus: A Post Hoc Exploratory Analysis

Randomized Trial of the Effects of Insulin and Metformin on Myocardial Injury and Stress in Diabetes Mellitus: A Post Hoc Exploratory Analysis

Biological variation of high sensitivity cardiac troponin-T in stable dialysis patients: implications for clinical practice

High-sensitivity cardiac troponin T is a predictor of recurrent acute coronary syndrome in patients with acute myocardial infarction

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