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

• Published in: Endocrinología, diabetes y nutrición diabetes y nutrición, 2021-05, Vol.68 (5), p.321-328
• Main Authors: Bluro, Ignacio M., Nardi, María A., De Miguel, Raúl, Fernández, Martín, Rolando, Jesica Y., Abraham Fóscolo, Maria M., Denaday, Lisandro R., Candenas, Nereo, Cagide, Arturo M., Pizarro, Rodolfo, Furci, Aida
• Format: Article
• Language: English
• Subjects: Cardiovascular disease; Diabetes mellitus type 2; Diabetes tipo 2; Enfermedad cardiovascular; Troponin; Troponina
• ISSN: 2530-0164; 2530-0180
• DOI: 10.1016/j.endinu.2020.05.007

The objective of this work was to define a value for the 99th percentile of high-sensitive troponin T and to evaluate the prognostic value of this biomarker in a population of patients with type 2 diabetes without a history of cardiovascular disease. In this prospective, observational and analytic study, 482 patients with type 2 diabetes were enrolled. The patients were asymptomatic, with no history of cardiovascular events, renal insufficiency, or inflammatory or systemic disease. As events we considered a combined end point of major adverse cardiovascular events (MACE). 94.9% of the patients had detectable troponin values, 20.7% of the patients had troponin values above the healthy population reference upper threshold (14pg/mL). The 99th percentile value for this patient population was 48pg/mL. Age, sex, the glomerular filtration rate and hypertension were associated with troponin values>14pg/mL. The incidence of MACE was 3.96 per 100 patients/year (p/y) between those with hs-TnT>14pg/mL and 1.07 per 100 p/y between those with hs-TnT≤14pg/mL (HR=3.78 CI95 1.49–9.58; p=0.005). The 99th percentile value of troponin T in a population of patients with type 2 diabetes is 3-fold higher than the value proposed by the manufacturer for a healthy population. We also observed a significant difference in the distribution of troponin T values between men and women. This biomarker may be a valuable prognostic factor, since troponin T values above the reference upper threshold were associated with an increase in the risk of cardiovascular events in these patients. Definir un valor para el percentil 99 de la troponina T ultrasensible (TnTus) y evaluar el valor pronóstico de este biomarcador en una población de pacientes con diabetes tipo 2 sin antecedentes cardiovasculares. Se incluyeron en este estudio prospectivo, observacional y analítico 482 pacientes con diabetes tipo 2. No tenían síntomas ni antecedentes de episodios cardiovasculares, insuficiencia renal ni enfermedad inflamatoria o sistémica. Consideramos como episodios un criterio de valoración combinado de episodios cardiovasculares adversos importantes (ECAI). El 94,9% de los pacientes tenían valores de troponina detectable, el 20,7% tenían valores de troponina por encima del umbral superior de referencia de la población sana (14pg/mL). El percentil 99 de esta población de pacientes era de 48pg/mL. La edad, el sexo, la filtración glomerular y la hipertensión se asociaban con valores de troponina >14pg/mL. La i