Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://www.cardiologyres.org

Original Article

Volume 8, Number 6, December 2017, pages 304-311

Association of Hemorheology With High-Sensitivity Cardiac Troponin T Levels in Patients With Type 2 Diabetes Mellitus Assessed by Microchannel Array Flow Analyzer

Figure 1. System of microchannel array flow analyzer. The microchannel passage time of 100 µL of physiologic saline was measured as a control, and then that of venous whole blood obtained from the subjects with 5% heparinization was determined. The whole blood passage time of the subjects was expressed after correction for the passage time of physiologic saline. Inter- and intra-assay coefficients of variation for whole blood passage time were 8% and 5%, respectively.

Figure 2. Relationship between hs-cTnT and WBPT. There is significantly positive correlations between log-hs-cTnT and WBPT (r = 0.40, P < 0.001). hs-cTnT: high sensitivity cardiac troponin T; WBPT: whole blood passage time.

Figure 3. Results of multiple logistic regression analysis for high hs-cTnT. Patients with high (≥ 70 s; odds ratio, 5.3 (95% CI, 1.6 - 16.1); P < 0.01) and median (50.2 - 69.8 s; odds ratio, 3.8 (95% CI, 1.2 - 12.4); P < 0.05) WBPT had a significantly higher risk for high hs-cTnT levels (≥ 0.014 ng/mL) than those with low WBPT (≤ 50.0 s). Adjustment factors: CAVI, log-BNP, skin AF, d-ROMs test, age. *P < 0.05 vs. ≤ 50.0 s, **P < 0.01 vs. ≤ 50.0 s. CI: confidence interval; CAVI: cardio-ankle vascular index; BNP: brain natriuretic peptide; AF: autofluorescence; d-ROMs: derivatives of reactive oxygen metabolites.

**Table 1.** Patient Characteristics
	Overall	hs-cTnT non-detection	hs-cTnT detection	P value
Data are expressed as mean ± standard deviation. hs-cTnT: high-sensitivity cardiac troponin T; BP: blood pressure; LDL: low-density lipoprotein; HDL: high-density lipoprotein; FBG: fasting blood glucose; IRI: immunoreactive insulin; HOMA-IR: homeostatic model assessment of insulin resistance; AF: autofluorescence; eGFR: estimated glomerular filtration rate; BNP: brain natriuretic peptide; d-ROMs: derivatives of reactive oxygen metabolites; CAVI: cardio-ankle vascular index; WBPT: whole blood passage time; DPP: dipeptidyl peptidase; RAS: renin-angiotensin system.
n (male/female)	301 (116/185)	40 (18/22)	261 (98/163)	0.369
Age (years)	65 ± 11	61 ± 10	66 ± 12	< 0.01
Body mass index (kg/m²)	23 ± 4	21 ± 3	24 ± 4	< 0.01
Current smoker, n (%)	70 (23)	6 (15)	64 (24)	0.206
Hypertension, n (%)	211 (70)	28 (70)	183 (70)	0.920
Systolic BP (mm Hg)	140 ± 20	136 ± 15	140 ± 20	0.053
Diastolic BP (mm Hg)	87 ± 13	84 ± 11	88 ± 13	0.059
Dyslipidemia (%)	178 (59)	23 (58)	155 (59)	0.874
Total cholesterol (mg/dL)	219 ± 41	216 ± 40	219 ± 41	0.433
LDL cholesterol (mg/dL)	140 ± 38	137 ± 37	140 ± 38	0.559
Triglyceride (mg/dL)	146 ± 70	142 ± 83	146 ± 69	0.485
HDL cholesterol (mg/dL)	50 ± 16	51 ± 15	50 ± 16	0.890
FBG (mg/dL)	133 ± 27	123 ± 28	134 ± 27	< 0.05
IRI (µg/mL)	7.8 ± 4.8	6.7 ± 4.9	8.0 ± 4.8	0.068
HOMA-IR	2.6 ± 1.0	2.1 ± 1.6	2.6 ± 1.6	0.052
Hemoglobin A1c (%)	7.1 ± 1.0	6.8 ± 0.9	7.1 ± 1.0	< 0.05
SkinAF (AU)	2.7 ± 0.6	2.0 ± 0.4	2.8 ± 0.7	< 0.001
White blood cell (/µL)	5,371 ± 1,587	4,965 ± 1,086	5,433 ± 1,643	0.082
Hematocrit (%)	42.6 ± 4.9	42.5 ± 5.2	42.6 ± 4.8	0.853
Platelet (10⁴/µL)	23.1 ± 5.5	21.8 ± 6.9	23.3 ± 5.3	0.119
eGFR (mL/min/1.73 m²)	67 ± 20	73 ± 19	66 ± 21	< 0.05
Cornell voltage (mm)	15 ± 5	13 ± 4	15 ± 5	< 0.05
Log-BNP (pg/mL)	1.7 ± 0.4	1.4 ± 0.4	1.8 ± 0.3	< 0.001
d-ROMs test (U. Carr)	336 ± 108	259 ± 82	348 ± 107	< 0.001
CAVI	9.2 ± 1.5	8.6 ± 1.3	9.4 ± 1.5	< 0.001
WBPT (s)	63 ± 18	50 ± 13	64 ± 18	< 0.001
Log-hs-cTnT (ng/mL)	-1.9 ± 0.2	-	-1.9 ± 0.2	-
Medication
Sulfonylurea, n (%)	217 (72)	29 (73)	188 (72)	0.951
Metformin, n (%)	84 (28)	12 (29)	72 (28)	0.903
DPP-4 inhibitor, n (%)	160 (53)	20 (50)	140 (54)	0.669
Insulin, n (%)	18 (6)	3 (8)	15 (6)	0.887
RAS inhibitor, n (%)	175 (58)	20 (50)	155 (59)	0.157
Statin, n (%)	138 (46)	16 (40)	122 (47)	0.276

Table 1. Patient Characteristics

Overall

hs-cTnT non-detection

hs-cTnT detection

P value

Data are expressed as mean ± standard deviation. hs-cTnT: high-sensitivity cardiac troponin T; BP: blood pressure; LDL: low-density lipoprotein; HDL: high-density lipoprotein; FBG: fasting blood glucose; IRI: immunoreactive insulin; HOMA-IR: homeostatic model assessment of insulin resistance; AF: autofluorescence; eGFR: estimated glomerular filtration rate; BNP: brain natriuretic peptide; d-ROMs: derivatives of reactive oxygen metabolites; CAVI: cardio-ankle vascular index; WBPT: whole blood passage time; DPP: dipeptidyl peptidase; RAS: renin-angiotensin system.

n (male/female)

301 (116/185)

40 (18/22)

261 (98/163)

0.369

Age (years)

65 ± 11

61 ± 10

66 ± 12

< 0.01

Body mass index (kg/m²)

23 ± 4

21 ± 3

24 ± 4

< 0.01

Current smoker, n (%)

70 (23)

6 (15)

64 (24)

0.206

Hypertension, n (%)

211 (70)

28 (70)

183 (70)

0.920

Systolic BP (mm Hg)

140 ± 20

136 ± 15

140 ± 20

0.053

Diastolic BP (mm Hg)

87 ± 13

84 ± 11

88 ± 13

0.059

Dyslipidemia (%)

178 (59)

23 (58)

155 (59)

0.874

Total cholesterol (mg/dL)

219 ± 41

216 ± 40

219 ± 41

0.433

LDL cholesterol (mg/dL)

140 ± 38

137 ± 37

140 ± 38

0.559

Triglyceride (mg/dL)

146 ± 70

142 ± 83

146 ± 69

0.485

HDL cholesterol (mg/dL)

50 ± 16

51 ± 15

50 ± 16

0.890

FBG (mg/dL)

133 ± 27

123 ± 28

134 ± 27

< 0.05

IRI (µg/mL)

7.8 ± 4.8

6.7 ± 4.9

8.0 ± 4.8

0.068

HOMA-IR

2.6 ± 1.0

2.1 ± 1.6

2.6 ± 1.6

0.052

Hemoglobin A1c (%)

7.1 ± 1.0

6.8 ± 0.9

7.1 ± 1.0

< 0.05

SkinAF (AU)

2.7 ± 0.6

2.0 ± 0.4

2.8 ± 0.7

< 0.001

White blood cell (/µL)

5,371 ± 1,587

4,965 ± 1,086

5,433 ± 1,643

0.082

Hematocrit (%)

42.6 ± 4.9

42.5 ± 5.2

42.6 ± 4.8

0.853

Platelet (10⁴/µL)

23.1 ± 5.5

21.8 ± 6.9

23.3 ± 5.3

0.119

eGFR (mL/min/1.73 m²)

67 ± 20

73 ± 19

66 ± 21

< 0.05

Cornell voltage (mm)

15 ± 5

13 ± 4

15 ± 5

< 0.05

Log-BNP (pg/mL)

1.7 ± 0.4

1.4 ± 0.4

1.8 ± 0.3

< 0.001

d-ROMs test (U. Carr)

336 ± 108

259 ± 82

348 ± 107

< 0.001

CAVI

9.2 ± 1.5

8.6 ± 1.3

9.4 ± 1.5

< 0.001

WBPT (s)

63 ± 18

50 ± 13

64 ± 18

< 0.001

Log-hs-cTnT (ng/mL)

-1.9 ± 0.2

Medication

Sulfonylurea, n (%)

217 (72)

29 (73)

188 (72)

0.951

Metformin, n (%)

84 (28)

12 (29)

72 (28)

0.903

DPP-4 inhibitor, n (%)

160 (53)

20 (50)

140 (54)

0.669

Insulin, n (%)

18 (6)

3 (8)

15 (6)

0.887

RAS inhibitor, n (%)

175 (58)

20 (50)

155 (59)

0.157

Statin, n (%)

138 (46)

16 (40)

122 (47)

0.276

**Table 2.** Correlation Between Hs-cTnT, WBPT and Clinical Parameters in Hs-cTnT Detectable Patients
	r
r expressed correlation coefficient. P < 0.05, P < 0.01, **P < 0.001. hs-cTnT: high-sensitivity cardiac troponin T; BP: blood pressure; LDL: low-density lipoprotein; HDL: high-density lipoprotein; FBG: fasting blood glucose; IRI: immunoreactive insulin; HOMA-IR: homeostatic model assessment of insulin resistance; AF: autofluorescence; eGFR: estimated glomerular filtration rate; BNP: brain natriuretic peptide; d-ROMs: derivatives of reactive oxygen metabolites; CAVI: cardio-ankle vascular index; WBPT: whole blood passage time; DPP: dipeptidyl peptidase; RAS: renin-angiotensin system.
Sex (female = 0, male = 1)	0.04	0.06
Age	0.19**	0.03
Body mass index	0.14*	0.18**
Current smoker (no = 0, yes = 1)	0.07	0.20**
Hypertension (no = 0, yes = 1)	0.12*	0.13*
Systolic BP	0.08	0.10
Diastolic BP	0.06	0.08
Dyslipidemia (no = 0, yes = 1)	-0.03	-0.01
Total cholesterol	-0.04	0.08
LDL cholesterol	-0.05	0.07
Triglyceride	-0.03	0.21**
HDL cholesterol	-0.07	-0.09
FBG	0.07	0.11
IRI	0.05	0.07
HOMA-IR	0.06	0.10
Hemoglobin A1c	0.13*	0.13*
Skin AF	0.32***	0.36***
White blood cell	0.06	0.13*
Hematocrit	0.05	0.20**
Platelet	0.03	0.08
eGFR	-0.19**	-0.14*
Cornell voltage	0.22***	0.10
Log-BNP	0.35***	0.07
d-ROMs test	0.30***	0.40***
CAVI	0.41***	0.42***
Sulfonylurea (no = 0, yes = 1)	-0.05	-0.08
Metformin (no = 0, yes = 1)	-0.03	-0.03
DPP-4 inhibitor (no = 0, yes = 1)	-0.05	-0.06
Insulin (no = 0, yes = 1)	-0.05	-0.06
RAS inhibitor (no = 0, yes = 1)	-0.09	-0.07
Statin (no = 0, yes = 1)	-0.07	-0.09

Table 2. Correlation Between Hs-cTnT, WBPT and Clinical Parameters in Hs-cTnT Detectable Patients

Log-hs-cTnT

WBPT

r expressed correlation coefficient. *P < 0.05, **P < 0.01, ***P < 0.001. hs-cTnT: high-sensitivity cardiac troponin T; BP: blood pressure; LDL: low-density lipoprotein; HDL: high-density lipoprotein; FBG: fasting blood glucose; IRI: immunoreactive insulin; HOMA-IR: homeostatic model assessment of insulin resistance; AF: autofluorescence; eGFR: estimated glomerular filtration rate; BNP: brain natriuretic peptide; d-ROMs: derivatives of reactive oxygen metabolites; CAVI: cardio-ankle vascular index; WBPT: whole blood passage time; DPP: dipeptidyl peptidase; RAS: renin-angiotensin system.

Sex (female = 0, male = 1)

0.04

0.06

Age

0.19**

0.03

Body mass index

0.14*

0.18**

Current smoker (no = 0, yes = 1)

0.07

0.20**

Hypertension (no = 0, yes = 1)

0.12*

0.13*

Systolic BP

0.08

0.10

Diastolic BP

0.06

0.08

Dyslipidemia (no = 0, yes = 1)

-0.03

-0.01

Total cholesterol

-0.04

0.08

LDL cholesterol

-0.05

0.07

Triglyceride

-0.03

0.21**

HDL cholesterol

-0.07

-0.09

FBG

0.07

0.11

IRI

0.05

0.07

HOMA-IR

0.06

0.10

Hemoglobin A1c

0.13*

Skin AF

0.32***

0.36***

White blood cell

0.06

0.13*

Hematocrit

0.05

0.20**

Platelet

0.03

0.08

eGFR

-0.19**

-0.14*

Cornell voltage

0.22***

0.10

Log-BNP

0.35***

0.07

d-ROMs test

0.30***

0.40***

CAVI

0.41***

0.42***

Sulfonylurea (no = 0, yes = 1)

-0.05

-0.08

Metformin (no = 0, yes = 1)

-0.03

DPP-4 inhibitor (no = 0, yes = 1)

-0.05

-0.06

Insulin (no = 0, yes = 1)

-0.05

-0.06

RAS inhibitor (no = 0, yes = 1)

-0.09

-0.07

Statin (no = 0, yes = 1)

-0.07

-0.09

**Table 3.** Multiple Regression Analysis
Explanatory factor	β	P value
(A) Subordinate factor is hs-cTnT R² = 0.3. (B) Subordinate factor is WBPT R² = 0.44. CAVI: cardio-ankle vascular index; WBPT: whole blood passage time; BNP: brain natriuretic peptide; AF: autofluorescence; d-ROMs: derivatives of reactive oxygen metabolite; eGFR: estimated glomerular filtration rate; hs-cTnT: high-sensitivity cardiac troponin T.
(A)
CAVI	0.27	< 0.001
WBPT	0.24	< 0.001
Log-BNP	0.21	< 0.01
Skin AF	0.20	< 0.01
d-ROMs test	0.19	< 0.05
Age	0.18	< 0.05
Cornell voltage	0.09	0.104
eGFR	-0.06	0.251
(B)
Skin AF	0.36	< 0.001
Log-hs-cTnT	0.29	< 0.001
d-ROMs test	0.19	< 0.01
CAVI	0.15	< 0.05
Hematocrit	0.13	< 0.05
Current smoker	0.12	< 0.05
Triglyceride	0.04	0.387

Table 3. Multiple Regression Analysis

Explanatory factor

P value

(A) Subordinate factor is hs-cTnT R² = 0.3. (B) Subordinate factor is WBPT R² = 0.44. CAVI: cardio-ankle vascular index; WBPT: whole blood passage time; BNP: brain natriuretic peptide; AF: autofluorescence; d-ROMs: derivatives of reactive oxygen metabolite; eGFR: estimated glomerular filtration rate; hs-cTnT: high-sensitivity cardiac troponin T.

(A)

CAVI

0.27

< 0.001

WBPT

0.24

< 0.001

Log-BNP

0.21

< 0.01

Skin AF

0.20

< 0.01

d-ROMs test

0.19

< 0.05

Age

0.18

< 0.05

Cornell voltage

0.09

0.104

eGFR

-0.06

0.251

(B)

Skin AF

0.36

< 0.001

Log-hs-cTnT

0.29

< 0.001

d-ROMs test

0.19

< 0.01

CAVI

0.15

< 0.05

Hematocrit

0.13

< 0.05

Current smoker

0.12

< 0.05

Triglyceride

0.04

0.387