Clinical significance of troponin elevations in acute decompensated diabetes without clinical acute coronary syndrome

<p>Abstract</p> <p>Background</p> <p>Elevation of cardiac troponin has been documented in multiple settings without acute coronary syndrome. However, its impact on long-term cardiac outcomes in the context of acute decompensated diabetes remains to be explored.</p>...

Full description

Bibliographic Details
Main Authors: Eubanks Anthony, Raza Farhan, Alkhouli Mohamad, Glenn April N, Homko Carol, Kashem Abul, Bove Alfred
Format: Article
Language:English
Published: BMC 2012-12-01
Series:Cardiovascular Diabetology
Subjects:
Online Access:http://www.cardiab.com/content/11/1/154
_version_ 1818661790814306304
author Eubanks Anthony
Raza Farhan
Alkhouli Mohamad
Glenn April N
Homko Carol
Kashem Abul
Bove Alfred
author_facet Eubanks Anthony
Raza Farhan
Alkhouli Mohamad
Glenn April N
Homko Carol
Kashem Abul
Bove Alfred
author_sort Eubanks Anthony
collection DOAJ
description <p>Abstract</p> <p>Background</p> <p>Elevation of cardiac troponin has been documented in multiple settings without acute coronary syndrome. However, its impact on long-term cardiac outcomes in the context of acute decompensated diabetes remains to be explored.</p> <p>Methods</p> <p>We performed a retrospective analysis of 872 patients admitted to Temple University Hospital from 2004–2009 with DKA or HHS. Patients were included if they had cardiac troponin I (cTnI) measured within 24 hours of hospital admission, had no evidence of acute coronary syndrome and had a follow up period of at least 18 months. Of the 264 patients who met the criteria, we reviewed the baseline patient characteristics, admission labs, EKGs and major adverse cardiovascular events during the follow up period. Patients were categorized into two groups with normal and elevated levels of cardiac enzymes. The composite end point of the study was the occurrence of a major cardiovascular event (MACE) during the follow up period and was compared between the two groups.</p> <p>Results</p> <p>Of 264 patients, 24 patients were found to have elevated cTnI. Compared to patients with normal cardiac enzymes, there was a significant increase in incidence of MACE in patients with elevated cTnI. In a regression analysis, which included prior history of CAD, HTN and ESRD, the only variable that independently predicted MACE was an elevation in cTnI (p = 0.044). Patients with elevated CK-MB had increased lengths of hospitalization compared to the other group (p < 0.001).</p> <p>Conclusions</p> <p>Elevated cardiac troponin I in patients admitted with decompensated diabetes and without evidence of acute coronary syndrome, strongly correlate with a later major cardiovascular event. Thus, elevated troponin I during metabolic abnormalities identify a group of patients at an increased risk for poor long-term outcomes. Whether these patients may benefit from early detection, risk stratification and preventive interventions remains to be investigated.</p>
first_indexed 2024-12-17T04:50:40Z
format Article
id doaj.art-2516e77fad6b4e0dbe1b561151af5024
institution Directory Open Access Journal
issn 1475-2840
language English
last_indexed 2024-12-17T04:50:40Z
publishDate 2012-12-01
publisher BMC
record_format Article
series Cardiovascular Diabetology
spelling doaj.art-2516e77fad6b4e0dbe1b561151af50242022-12-21T22:02:55ZengBMCCardiovascular Diabetology1475-28402012-12-0111115410.1186/1475-2840-11-154Clinical significance of troponin elevations in acute decompensated diabetes without clinical acute coronary syndromeEubanks AnthonyRaza FarhanAlkhouli MohamadGlenn April NHomko CarolKashem AbulBove Alfred<p>Abstract</p> <p>Background</p> <p>Elevation of cardiac troponin has been documented in multiple settings without acute coronary syndrome. However, its impact on long-term cardiac outcomes in the context of acute decompensated diabetes remains to be explored.</p> <p>Methods</p> <p>We performed a retrospective analysis of 872 patients admitted to Temple University Hospital from 2004–2009 with DKA or HHS. Patients were included if they had cardiac troponin I (cTnI) measured within 24 hours of hospital admission, had no evidence of acute coronary syndrome and had a follow up period of at least 18 months. Of the 264 patients who met the criteria, we reviewed the baseline patient characteristics, admission labs, EKGs and major adverse cardiovascular events during the follow up period. Patients were categorized into two groups with normal and elevated levels of cardiac enzymes. The composite end point of the study was the occurrence of a major cardiovascular event (MACE) during the follow up period and was compared between the two groups.</p> <p>Results</p> <p>Of 264 patients, 24 patients were found to have elevated cTnI. Compared to patients with normal cardiac enzymes, there was a significant increase in incidence of MACE in patients with elevated cTnI. In a regression analysis, which included prior history of CAD, HTN and ESRD, the only variable that independently predicted MACE was an elevation in cTnI (p = 0.044). Patients with elevated CK-MB had increased lengths of hospitalization compared to the other group (p < 0.001).</p> <p>Conclusions</p> <p>Elevated cardiac troponin I in patients admitted with decompensated diabetes and without evidence of acute coronary syndrome, strongly correlate with a later major cardiovascular event. Thus, elevated troponin I during metabolic abnormalities identify a group of patients at an increased risk for poor long-term outcomes. Whether these patients may benefit from early detection, risk stratification and preventive interventions remains to be investigated.</p>http://www.cardiab.com/content/11/1/154Cardiac troponin-IDecompensated diabetesPrognostic markersAcute coronary syndromeCK-MB
spellingShingle Eubanks Anthony
Raza Farhan
Alkhouli Mohamad
Glenn April N
Homko Carol
Kashem Abul
Bove Alfred
Clinical significance of troponin elevations in acute decompensated diabetes without clinical acute coronary syndrome
Cardiovascular Diabetology
Cardiac troponin-I
Decompensated diabetes
Prognostic markers
Acute coronary syndrome
CK-MB
title Clinical significance of troponin elevations in acute decompensated diabetes without clinical acute coronary syndrome
title_full Clinical significance of troponin elevations in acute decompensated diabetes without clinical acute coronary syndrome
title_fullStr Clinical significance of troponin elevations in acute decompensated diabetes without clinical acute coronary syndrome
title_full_unstemmed Clinical significance of troponin elevations in acute decompensated diabetes without clinical acute coronary syndrome
title_short Clinical significance of troponin elevations in acute decompensated diabetes without clinical acute coronary syndrome
title_sort clinical significance of troponin elevations in acute decompensated diabetes without clinical acute coronary syndrome
topic Cardiac troponin-I
Decompensated diabetes
Prognostic markers
Acute coronary syndrome
CK-MB
url http://www.cardiab.com/content/11/1/154
work_keys_str_mv AT eubanksanthony clinicalsignificanceoftroponinelevationsinacutedecompensateddiabeteswithoutclinicalacutecoronarysyndrome
AT razafarhan clinicalsignificanceoftroponinelevationsinacutedecompensateddiabeteswithoutclinicalacutecoronarysyndrome
AT alkhoulimohamad clinicalsignificanceoftroponinelevationsinacutedecompensateddiabeteswithoutclinicalacutecoronarysyndrome
AT glennapriln clinicalsignificanceoftroponinelevationsinacutedecompensateddiabeteswithoutclinicalacutecoronarysyndrome
AT homkocarol clinicalsignificanceoftroponinelevationsinacutedecompensateddiabeteswithoutclinicalacutecoronarysyndrome
AT kashemabul clinicalsignificanceoftroponinelevationsinacutedecompensateddiabeteswithoutclinicalacutecoronarysyndrome
AT bovealfred clinicalsignificanceoftroponinelevationsinacutedecompensateddiabeteswithoutclinicalacutecoronarysyndrome