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Open Access Original investigation

Predictive value of high-sensitivity troponin-I for future adverse cardiovascular outcome in stable patients with type 2 diabetes mellitus

Kai-Hang Yiu12, Kui-Kai Lau23, Chun-Ting Zhao1, Yap-Hang Chan1, Yan Chen1, Zhe Zhen1, Arthur Wong1, Chu-Pak Lau1 and Hung-Fat Tse12*

Author Affiliations

1 Cardiology Division, Department of Medicine, Queen Mary Hospital, the University of Hong Kong, Block K, Pokfulam, Hong Kong

2 Research Centre of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong, SAR, China

3 Division of Neurology, Department of Medicine, Queen Mary Hospital, the University of Hong Kong, Hong Kong, SAR, China

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Cardiovascular Diabetology 2014, 13:63  doi:10.1186/1475-2840-13-63

Published: 25 March 2014

Abstract

Introduction

High-sensitivity cardiac troponin I(hs-TnI) and T levels(hs-TnT) are sensitive biomarkers of cardiomyocyte turnover or necrosis. Prior studies of the predictive role of hs-TnT in type 2 diabetes mellitus(T2DM) patients have yielded conflicting results. This study aimed to determine whether hs-TnI, which is detectable in a higher proportion of normal subjects than hsTnT, is associated with a major adverse cardiovascular event(MACE) in T2DM patients.

Methods and results

We compared hs-TnI level in stored serum samples from 276 consecutive patients (mean age 65 ± 10 years; 57% male) with T2DM with that of 115 age-and sex-matched controls. All T2DM patients were prospectively followed up for at least 4 years for incidence of MACE including heart failure(HF), myocardial infarction(MI) and cardiovascular mortality. At baseline, 274(99%) patients with T2DM had detectable hs-TnI, and 57(21%) had elevated hs-TnI (male: 8.5 ng/L, female: 7.6 ng/L, above the 99th percentile in healthy controls). A total of 43 MACE occurred: HF(n = 18), MI(n = 11) and cardiovascular mortality(n = 14). Kaplan-Meier analysis showed that an elevated hs-TnI was associated with MACE, HF, MI and cardiovascular mortality. Although multivariate analysis revealed that an elevated hs-TnI independently predicted MACE, it had limited sensitivity(62.7%) and positive predictive value(38.5%). Contrary to this, a normal hs-TnI level had an excellent negative predictive value(92.2%) for future MACE in patients with T2DM.

Conclusion

The present study demonstrates that elevated hs-TnI in patients with T2DM is associated with increased MACE, HF, MI and cardiovascular mortality. Importantly, a normal hs-TnI level has an excellent negative predictive value for future adverse cardiovascular events during long-term follow-up.

Keywords:
Type 2 diabetes mellitus; High-sensitivity troponin I outcome