Urine High-Sensitivity Troponin I Predict Incident Cardiovascular Events in Patients with Diabetes Mellitus

Abstract

In patients with diabetes mellitus (DM), incident cardiovascular (CV) events are associated with poor long-term outcomes. Serum high-sensitivity troponin I (hs-TnI) is widely used to diagnose and predict outcomes in patients with acute coronary syndrome, however, few studies have investigated the accuracy of urine hs-TnI as a predictor for incident CV events in patients with DM. The enrolled participants included patients with DM. Fresh urine hs-TnI levels were measured. Medical records of enrolled patients were used to determine the number of incident CV events prospectively for 3 months. The study cohort comprised 378 participants. We observed significantly higher levels of urine hs-TnI in those with than without subsequent incident CV events. The multivariate logistic regression analysis using different models consistently showed that urine hs-TnI > 4.10 pg/mL was an independent factor predictive of incident CV events. The ROC-AUC analysis revealed that the optimal cutoff value for urine hs-TnI for predicting incident CV events was 1.55 pg/mL and the area was 0.611 (p = 0.027). A single measurement of urinary hs-TnI, collected easily and non-invasively, may be an acceptable biomarker for predicting subsequent incident CV events in patients with DM.

The Main Causes and Mechanisms of Increase in Cardiac Troponin Concentrations Other Than Acute Myocardial Infarction (Part 1): Physical Exertion, Inflammatory Heart Disease, Pulmonary Embolism, Renal Failure, Sepsis

“…The most likely reason why some researchers have failed to detect troponin in urine and thereby question the mechanism of renal elimination is the analytical sensitivity of immunoassays. 104 , 105 Thus, the levels of troponins in urine are small and range from only a few ng/L to several tens of ng/L - these concentrations can be detected only by highly sensitive and ultrasensitive immunoassays, while in conventional moderately sensitive methods used previously, the minimum detectable concentration was, as a rule, not less than 100 ng/l. Therefore, this low concentration of troponin molecules in the urine remained as insignificant and “invisible” to standard moderately sensitive immunoassays.…”

Elevation Mechanisms and Diagnostic Consideration of Cardiac Troponins under Conditions Not Associated with Myocardial Infarction. Part 1

“…However, it is also important to understand that the concentration of cardiac troponin isoforms in the blood serum depends not only on the mechanisms of troponin release from cardiomyocytes but also on the mechanisms of their elimination from the bloodstream. The most well-known methods for removing many proteins, in particular troponins, include cleavage by specific proteases inside the cells of the reticuloendothelial system; extracellular cleavage by proteases, such as thrombin; and renal filtration [75][76][77][78][79][80].…”

“…The most controversial mechanism for the elimination of troponins is glomerular filtration. Some researchers denied this mechanism of troponin removal since it was impossible to determine troponins in urine [ 78 ]. An indirect confirmation of the involvement of the kidneys in the elimination of troponins from the blood was the reports of clinicians about overestimated levels of troponins in patients suffering from chronic kidney disease without coronary artery disease.…”

Clinical characteristics and prognostic implications of diabetes and myocardial injury in patients admitted to the emergency room

“…Even the determination of Tnc in urine has been predictive of cardiovascular events in patients with diabetes. In the series by Chen, significantly higher levels of hs-TnI were observed in urine in those with subsequent incident CV events than in those without [ 20 ]. In studies with long-term follow-up, the association between Tnc levels and cardiovascular events in patients with diabetes is also observed.…”