Troponina T em mulheres com e sem diabetes mellitus gestacional: estudo longitudinal

Abstract

High-sensitivity cardiac troponin T (hs-TnT) is a well-established biomarker of myocardial injury. While hyperglycemia is associated with subclinical myocardial stress, little is known about hs-TnT dynamics during pregnancy, particularly in women with gestational diabetes mellitus (GDM). We investigated the longitudinal concentration changes in hs-TnT levels in pregnant women with and without GDM. In this prospective observational cohort study, we included 97 pregnant women (56 with GDM and 41 controls) recruited between July 2021 and December 2023. Hs-TnT levels, glycemic and lipid profiles, and clinical parameters were measured at three timepoints: T0 (24-28 gestational weeks), T1 (> 34 weeks), and T2 (3-6 months postpartum). Hs-TnT levels were detected by an electrochemiluminescence immunoassay. Data was analyzed with longitudinal quantile mixed models at the 0.05, 0.50, and 0.95 quantiles. Of the 97 participants, 73 completed follow-up. Hs-TnT levels increased significantly over time in women with higher baseline hs-TnT (upper quantile) during pregnancy and postpartum (T = 0.95; ß = 1.69 × 10-; p = 0.00002). No statistically significant differences in hs-TnT levels were observed between the GDM and control groups. Glycated hemoglobin showed a consistent, although non-significant, positive association with hs-TnT across all quantiles. In patients with high baseline troponin concentrations, hs-TnT levels rise throughout gestation and persist postpartum, regardless of GDM diagnosis. The absence of group differences may reflect effective glycemic control in the GDM cohort. These findings highlight the potential role of hs-TnT as a biomarker of early cardiac damage in pregnancy. [resumo fornecido pelo autor]