scholarly journals Independent Value of Cardiac Troponin T and Left Ventricular Global Longitudinal Strain in Predicting All-Cause Mortality among Stable Hemodialysis Patients with Preserved Left Ventricular Ejection Fraction

2014 ◽  
Vol 2014 ◽  
pp. 1-12 ◽  
Author(s):  
Junne-Ming Sung ◽  
Chi-Ting Su ◽  
Yu-Tzu Chang ◽  
Yu-Ru Su ◽  
Wei-Chuan Tsai ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Cardiac Troponin ◽  
Longitudinal Strain ◽  
Troponin T ◽  
Global Longitudinal Strain ◽  
Hemodialysis Patients ◽  
Left Ventricular ◽  
Cardiac Troponin T ◽  
Clinical Parameters ◽  
Echocardiographic Parameters

Using a speckle-tracking echocardiography (STE), we recently demonstrated that a left ventricular (LV) global longitudinal strain (GLS) ≥ −15% and the serum cardiac troponin T (cTnT) concentration are associated with mortality in stable hemodialysis patients with preserved LV ejection fraction (LVEF). In this study, we explored the relationship between cTnT and echocardiographic parameters and evaluated whether the prognostic value provided by cTnT is independent of a GLS ≥ −15% and vice versa. Eighty-eight stable hemodialysis patients with preserved LVEF were followed for 31 months. STE studies and measurements of cTnT were performed at baseline. CTnT concentration had a modest correlation with GLS (rs=0.44;P<0.001) but had a weak or nonsignificant correlation with other echocardiographic parameters. Adjusting for clinical parameters, hazard ratios for each increase of 0.01 ng/mL in cTnT, and a GLS ≥ −15% on mortality were 1.13 (P=0.009) and 3.09 (P=0.03) without significant interaction between cTnT and GLS ≥ −15%. In addition, an increased cTnT concentration, a GLS ≥ −15%, or their combination showed significant additional predictive value for mortality when included in models consisting of clinical parameters. Therefore, both cTnT and a GLS ≥ −15% are independent predictors of mortality and are useful for risk stratification.

scholarly journals Single-Point Cardiac Troponin T at Coronary Care Unit Discharge after Myocardial Infarction Correlates with Infarct Size and Ejection Fraction

2002 ◽  
Vol 48 (9) ◽  
pp. 1432-1436 ◽  
Author(s):  
Mauro Panteghini ◽  
Claudio Cuccia ◽  
Graziella Bonetti ◽  
Raffaele Giubbini ◽  
Franca Pagani ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Ejection Fraction ◽  
Infarct Size ◽  
Cardiac Troponin ◽  
Coronary Care Unit ◽  
Troponin T ◽  
Left Ventricular ◽  
Lv Function ◽  
Cardiac Troponin T ◽  
Coronary Care

Abstract Background: One of the major concerns in replacing creatine kinase MB (CK-MB) with cardiac troponins is the lack of evidence of the ability of troponins to estimate the size of acute myocardial infarction (AMI). We investigated the ability of a single measurement of cardiac troponin T (cTnT) at coronary care unit (CCU) discharge to estimate infarct size and assess left ventricular (LV) function in AMI patients. Methods: We studied 65 AMI patients in whom infarct size was estimated by CK-MB peak concentrations and gated single-photon emission computed tomography (SPECT) myocardial perfusion using technetium-99m sestamibi and LV function by SPECT imaging. Measurements of cTnT and SPECT were performed 72 h (median) after admission (range, 40–160 h). SPECT was also repeated 3 months later. Results: We found a significant correlation between cTnT and both the peak CK-MB concentrations (r = 0.76; P &lt;0.001) and the perfusion defect size at SPECT (r = 0.62; P &lt;0.001). cTnT was inversely related to LV ejection fraction (LVEF) assessed both early (r = −0.56; P &lt;0.001) and 3 months after AMI (r = −0.70; P &lt;0.001). cTnT &gt;2.98 μg/L predicted a LVEF &lt;40% at 3 months with a sensitivity of 86.7%, specificity of 81.4%, and a likelihood ratio for a positive test of 4.7 (95% confidence interval, 4.0–5.4). Conclusions: A single cTnT measurement at CCU discharge after AMI is useful as a noninvasive estimate of infarct size and for the assessment of LV function in routine clinical setting.

Abstract 17994: Echocardiographic parameters of Left Ventricular Size and Function as Predictors of Symptomatic Heart Failure in Patients with Low Normal Ejection Fraction Treated with Anthracyclines

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Negareh Mousavi ◽  
Timothy Tan ◽  
Mohammad Ali ◽  
Elkan F. Halpern ◽  
Lin Wang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Symptomatic Heart Failure ◽  
Echocardiographic Parameters ◽  
And Function

Objectives: The aim of this study was to assess whether baseline echocardiographic measures of left ventricular (LV) size and function predict the development of symptomatic heart failure or cardiac death (major adverse cardiac events, MACE) in patients treated with anthracyclines who have a pre-chemotherapy left ventricular ejection fraction (LVEF) in the low normal range (between 50-59%). Background: Anthracycline-induced symptomatic heart failure and impaired LVEF are late and often irreversible manifestations of anthracycline-induced cardiotoxicity. The value of echocardiographic parameters of myocardial size and function before chemotherapy to identify patients at high-risk for development of symptomatic heart failure in patients with low normal LVEF was studied. Methods: Patients with a LVEF between 50 and 59% before anthracyclines were selected. In these patients, LV volumes, LVEF and peak longitudinal strain (GLS) were measured. Individuals were followed for MACE and all-cause mortality over a median of 659 days (range; 3-3704 days). Results: Of 2234 patients undergoing echocardiography for pre-anthracycline assessment, 158 (7%) had a resting ejection fraction of 50-59%. Their average LV end-diastolic volume (LVEDV) was 101±22ml, LVEF was 54 ±3% and global longitudinal strain (GLS) was -17.7±2.6%. Twelve patients experienced a MACE (congestive heart failure) at a median of 173 days (range; 15-530). Age, diabetes, previous coronary artery disease, LVEDV, LVESV and GLS were all-predictive of MACE (P= 0.015, 0.0043 and 0.0065 for LVEDV, LVESV, and GLS respectively). LVEDV and GLS remained predictive of MACE when adjusted for age. Age and GLS were also predictive of overall mortality (p<0.0001 and 0.0105 respectively). Conclusions: In patients treated with anthracyclines with an LVEF of 50-59%, both baseline EDV and GLS predict the occurrence of MACE. These parameters may help target patients who could bene[[Unable to Display Character: &#64257;]]t from closer cardiac surveillance and earlier initiation of cardioprotective medical therapy.

scholarly journals Diagnostic Thresholds for Pre–Diabetes Mellitus and Diabetes Mellitus and Subclinical Cardiac Disease in the General Population: Data From the ACE 1950 Study

2021 ◽  
Author(s):  
Peder L. Myhre ◽  
Magnus N. Lyngbakken ◽  
Trygve Berge ◽  
Ragnhild Røysland ◽  
Erika N. Aagaard ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Cardiac Disease ◽  
Cardiac Troponin ◽  
Ventricular Remodeling ◽  
Troponin T ◽  
Left Ventricular Remodeling ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Cardiac Troponin T ◽  
Cardiovascular Biomarkers

Background Diabetes mellitus (DM) is associated with left ventricular remodeling and incident heart failure, but the association between glycated hemoglobin A1c (HbA1c) and subclinical cardiac disease is not established. We aimed to determine the associations between HbA1c and (1) echocardiographic measures of left ventricular structure and function, and (2) cardiovascular biomarkers: cardiac troponin T, NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide), and CRP (C‐reactive protein). Methods and Results Participants (n=3688) born in 1950 from the population‐based ACE (Akershus Cardiac Examination) 1950 Study were classified as DM (HbA1c≥6.5% or self‐reported DM), pre‐DM (HbA1c 5.7%–6.5%), and no‐DM (HbA1c<5.7%). DM, pre‐DM, and no‐DM were classified in 380 (10%), 1630 (44%), and 1678 (46%) participants, respectively. Mean age was 63.9±0.7 years, mean body mass index was 27.2±4.4 kg/m 2 , and 49% were women. Higher HbA1c was associated with worse left ventricular systolic (ejection fraction and global longitudinal strain) and diastolic (E/e'‐ratio) function, myocardial injury (cardiac troponin T), inflammation (CRP), and impaired neurohormonal homeostasis (NT‐proBNP) ( P <0.001 in unadjusted and P <0.01 in adjusted analysis for all). The associations between HbA1c and cardiovascular biomarkers were independent of the echocardiographic variables, and vice versa. Associations were nonlinear ( P <0.05 for nonlinearity) and appeared stronger in the pre‐DM range of HbA1c than the no‐DM and DM range. Conclusions HbA1c was associated with indexes of subclinical cardiovascular disease, and this was more pronounced in pre‐DM. Our results suggest that cardiovascular preventive measures should be considered also in subjects with hyperglycemia and HbA1c below the established DM cutoff. Registration clinicaltrials.gov. Identifier: NCT01555411.

scholarly journals High-Sensitive Cardiac Troponin T for Prediction of Cardiovascular Outcomes in Stable Maintenance Hemodialysis Patients: A 3-Year Prospective Study

2021 ◽  
pp. 1-11
Author(s):  
Linlin Sun ◽  
Yonglan Wang ◽  
Nan Zhang ◽  
Xinmiao Xie ◽  
Miao Ding ◽  
...  
Keyword(s):  
Cardiac Troponin ◽  
Prognostic Value ◽  
Troponin T ◽  
Hemodialysis Patients ◽  
Maintenance Hemodialysis ◽  
Cardiac Troponin T ◽  
All Cause Mortality ◽  
Echocardiographic Parameters ◽  
Stable Maintenance

<b><i>Background:</i></b> Hemodialysis patients, who are often excluded from cardiovascular (CV) clinical trials, are associated with higher CV morbidity and mortality. The risk stratification scheme for these patients is lacking. Therefore, this investigation examined the independent CV prognostic value of high-sensitive cardiac troponin T (hs-cTnT) and added prognostic value over echocardiographic parameters and other clinical risk predictors in asymptomatic stable maintenance hemodialysis (MHD) patients. <b><i>Methods:</i></b> 181 patients with end-stage renal disease undergoing MHD were eligible from the dialysis center of Tongren Hospital, Shanghai Jiao Tong University School of Medicine between October 2017 and September 2018. These patients were followed until September 2020 or until death. The median follow-up was 31 (IQR: 21–33) months. Outcome measures were all-cause mortality, first fatal or nonfatal CV events (CVEs), and 4-point composite major adverse CVEs (MACE). We performed multivariable Cox regression analysis using demographic, clinical, laboratory, and echocardiographic data to identify predictors of CV outcomes. We also evaluated the increased discriminative value associated with the addition of echocardiographic parameters and hs-cTnT using net reclassification improvement (NRI) and integrated discrimination improvement (IDI). <b><i>Results:</i></b> During follow-up, 37 patients died, 84 patients suffered one or more CVEs, and 78 patients developed 4-point MACE. In univariable analyses, age, dialysis vintage, diastolic blood pressure, parathyroid hormone concentrations, hs-cTnT, B-type natriuretic peptide, left ventricular mass index (LVMI), and <i>E</i>/<i>E</i>′ predicted all end points. hs-cTnT remained a strong predictor for each end point in multivariate analysis, whereas LVMI and <i>E</i>/<i>E</i>′ did not. The addition of hs-cTnT on top of clinical and echocardiographic variables was associated with improvements in reclassification for CVEs (NRI = 44.6% [15.9–74.3%], IDI = 15.9% [5.7–31.0%], all <i>p</i> &#x3c; 0.001), all-cause mortality (NRI = 35.5% [10.1–50.2%], <i>p</i> &#x3c; 0.001, IDI = 4.4% [1.3–8.5%], <i>p</i> = 0.005), and 4-point MACE (NRI = 47.2% [16.1–64.9%], <i>p</i> &#x3c; 0.001, IDI = 16.9% [5.5–37.3%], <i>p</i> = 0.005). Adding echocardiographic variables on top of clinical variables and hs-cTnT was not associated with significant improvements in NRI and IDI (all <i>p</i> &#x3e; 0.05). <b><i>Conclusions:</i></b> Our data suggest that hs-cTnT is a powerful independent predictor of CV outcome and all-cause mortality in stable MHD patients. The additional use of echocardiography for improvement of risk stratification is not supported by our results.

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