Predictive value of high-sensitivity troponin-l for adverse cardiovascular outcomes in patients with type 2 diabetes mellitus

Abstract

Background: High-sensitivity cardiac troponins I (hs-TnI) and T levels (hs-TnT) are sensitive biomarkers of cardiomyocytes turnover or necrosis. Prior studies on the predictive role of hs-TnT in type 2 diabetes mellitus (T2DM) patients had yielded conflicting results. This study aimed to determine whether hs-TnI, which is detectable in a higher proportion of normal subjects than hsTnT are associated with adverse cardiovascular events in T2DM patients. Methods: We measured hs-TnI level in 276 consecutive patients (mean age 65±10 years; 57% male) with T2DM compared with 115 age-and sex-matched controls. All T2DM patients were prospectively followed up for at least 4 years for incident of major adverse cardiovascular events (MACE) including heart failure (HF), myocardial infarction (MI) and cardiovascular mortality. Results: At baseline, 274 (99%) patients had detectable hs-TnI, and 57 (21%) of them had elevated hs-TnI (male: 8.5 ng/L, female: 7.6ng/L, above the 99th percentile in healthy controls). A total of 43 MACE included HF (n=18), MI (n=11) and cardiovascular mortality (n=14) occurred. Kaplan-Meier analysis showed that an elevated hs-TnI was associated with MACE (Figure), HF, and cardiovascular mortality but not MI. Although multivariate analysis revealed elevated hs-TnI independently predicts MACE, it had limited sensitivity (62.7%) and positive predictive value (38.5%) for MACE. Conversely, a normal hs-TnI level had an excellent negative predictive value (92.2%) for adverse cardiovascular events. Conclusion: Our results demonstrated that elevated hs-TnI in T2DM patients is associated with increased MACE, HF and cardiovascular mortality. Importantly, a normal hs-TnI level has an excellent negative predictive value for adverse cardiovascular events in T2DM patients during long-term follow-up.