Abstract 14374: Prognostic Value of Combination of High-Sensitivity Troponin T and B-Type Natriuretic Peptide in Outpatients With Type 2 Diabetes Mellitus
Background: The risk of cardiovascular events is increased in patients with diabetic mellitus. More accurate identification of these patients at high risk for cardiovascular events may facilitate more aggressive and focused treatment. We prospectively investigated whether the combination of high-sensitivity troponin T (hsTnT), a marker for myocardial damage, and B-type natriuretic peptide (BNP), a marker for left ventricular overload, would be effective for the risk stratification in diabetic outpatients.
Methods: We measured serum hsTnT and plasma BNP in 509 consecutive outpatients with type 2 diabetes mellitus. Among these patients, 10.3% had a history of old myocardial infarction, and 60.2% had a history of hypertension.
Results: Log hsTnT levels positively correlated with log BNP (r = 0.51, p <0.0001). During a mean follow-up of 1214 days, there were 88 (17.3%) cardiovascular events including 15 cardiovascular deaths, and 37 all-cause deaths. Comparably, outpatients who had a cardiovascular event were older (median, 71 vs. 66 yrs, p < 0.001), had higher levels of hsTnT (14 vs. 8 pg/mL, p < 0.0001), BNP (48 vs. 25 pg/mL, p =0.0001), high sensitive C-reactive protein (0.85 vs. 0.58 mg/L, p = 0.005) and urinary albumin excretion (997 vs. 565 mg/g creatinine, p = 0.04), and displayed a lower level of estimated GFR (51.2 vs. 67.6 mL/min/1.73m2, p < 0.0001) than those who did not. On a multivariate Cox regression analysis including 7 clinical and biochemical variables, increased hsTnT (relative risk 2.93 per 10-fold increment, p = 0.004) and BNP (1.75 per 10-fold increment, p = 0.05) were independent predictors of cardiovascular events. HsTnT > median value of 9 pg/mL and/or BNP >median value of 27.5 pg/mL were associated with increased all-cause mortality and cardiovascular event rates (Table ).
Conclusion: The combination of hsTnT and BNP measurements could more accurately predict adverse outcome than either alone in outpatients with type2 diabetes mellitus.
- © 2013 by American Heart Association, Inc.