Elevated Cardiac Troponin T Predicts Cardiovascular Events in Asymptomatic Continuous Ambulatory Peritoneal Dialysis Patients without a History of Cardiovascular Disease

Abstract Background: We investigated whether cardiac troponin T (cTnT) independently predicted outcome and added prognostic value over other clinical risk predictors in chronic peritoneal dialysis (PD) with end-stage renal disease. Methods: Baseline cTnT, echocardiography, indices of dialysis adequacy, and biochemical characteristics were assessed in 238 chronic PD patients who were followed prospectively for 3 years or until death. Results: Using multivariable Cox regression analysis, cTnT remained predictive of all-cause mortality [hazard ratio 4.43, 95% CI 1.87–10.45, P = 0.001], cardiovascular death (4.12, 1.29–13.17, P = 0.017), noncardiovascular death (8.06, 1.86–35.03, P = 0.005), and fatal and nonfatal cardiovascular events (CVEs) (3.59, 1.48–8.70, P = 0.005) independent of background coronary artery disease, inflammation, residual renal function, left ventricular hypertrophy, and systolic dysfunction. cTnT alone had better predictive value than C-reactive protein (CRP) alone for mortality [area under the ROC curve (AUC) 0.774 vs 0.691; P = 0.089] and first CVE (AUC 0.711 vs 0.593; P = 0.009) at 3 years. Survival models including age, sex, and clinical, biochemical, and echocardiographic characteristics yielded AUCs of 0.813 (95% CI, 0.748–0.877), 0.800 (95% CI, 0.726–0.874), and 0.769 (95% CI, 0.708–0.830), respectively, in relation to all-cause mortality, cardiovascular death, and fatal and nonfatal cardiovascular events. After addition of cTnT, AUCs of the above models increased significantly to 0.832 (95% CI, 0.669–0.894; P = 0.0037), 0.810 (95% CI, 0.739–0.883; P = 0.0036), and 0.780 (95% CI, 0.720–0.840; P = 0.0002), respectively; no AUCs increased when CRP was added. Conclusions: cTnT is an independent predictor of long-term mortality, cardiovascular death and events, and noncardiovascular death in PD patients.

Download Full-text

Cardiac troponin I, cardiac troponin T, and creatine kinase MB in dialysis patients without ischemic heart disease: evidence of cardiac troponin T expression in skeletal muscle

Clinical Chemistry ◽

10.1093/clinchem/43.6.976 ◽

1997 ◽

Vol 43 (6) ◽

pp. 976-982 ◽

Cited By ~ 133

Author(s):

Mary D McLaurin ◽

Fred S Apple ◽

Ellen M Voss ◽

Charles A Herzog ◽

Scott W Sharkey

Keyword(s):

Skeletal Muscle ◽

Heart Disease ◽

Ischemic Heart Disease ◽

Cardiac Troponin ◽

First Generation ◽

Troponin T ◽

Ischemic Heart ◽

Cardiac Troponin T ◽

Dialysis Patients ◽

Acute Ischemic Heart Disease

Abstract Serum cardiac troponin T (cTnT) concentrations are frequently increased in chronic dialysis patients as measured by the first-generation ELISA immunoassay, as is creatine kinase (CK) MB mass in the absence of acute ischemic heart disease. We designed this study to compare four serum markers of myocardial injury [CK-MB mass, first-generation ELISA cTnT, second-generation Enzymun cTnT, and cardiac troponin I (cTnI)] in dialysis patients without acute ischemic heart disease. We also evaluated skeletal muscle from dialysis patients as a potential source of serum cTnT. No patients in the clinical evaluation group (n = 24) studied by history and by physical examination, electrocardiography, and two-dimensional echocardiography had evidence of ischemic heart disease. Biochemical markers were measured in serial predialysis blood samples with specific monoclonal antibody-based immunoassays. For several patients at least one sample measured above the upper reference limit: CK-MB, 7 of 24 (30%); ELISA cTnT, 17 of 24 (71%); Enzymun cTnT, 3 of 18 (17%); and cTnI, 1 of 24 (4%). In a separate group of dialysis patients (n = 5), expression of cTnT, but not cTnI, was demonstrated by Western blot analysis in 4 of 5 skeletal muscle biopsies. Chronic dialysis patients without acute ischemic heart disease frequently had increased serum CK-MB and cTnT. The specificity of the second-generation cTnT (Enzymun) assay was improved over that of the first-generation (ELISA) assay; cTnI was the most specific of the currently available biochemical markers. cTnT, but not cTnI, was expressed in the skeletal muscle of dialysis patients.

Download Full-text

Comment on Hillis et al. The Relative and Combined Ability of High-Sensitivity Cardiac Troponin T and N-Terminal Pro-B-Type Natriuretic Peptide to Predict Cardiovascular Events and Death in Patients With Type 2 Diabetes. Diabetes Care 2014;37:295–303

Diabetes Care ◽

10.2337/dc14-0052 ◽

2014 ◽

Vol 37 (6) ◽

pp. e152-e153

Author(s):

Stephanie Neuhold ◽

Richard Pacher ◽

Martin Hülsmann

Keyword(s):

Type 2 Diabetes ◽

Natriuretic Peptide ◽

Diabetes Care ◽

Cardiac Troponin ◽

Cardiovascular Events ◽

Troponin T ◽

High Sensitivity ◽

Cardiac Troponin T

Download Full-text

Major and Minor Risk Factors for Cardiovascular Disease in Continuous Ambulatory Peritoneal Dialysis Patients

Peritoneal Dialysis International ◽

10.1177/089686089901902s21 ◽

1999 ◽

Vol 19 (2_suppl) ◽

pp. 133-137 ◽

Cited By ~ 5

Author(s):

Sarah Prichard

Keyword(s):

Oxidative Stress ◽

Risk Factors ◽

Cardiovascular Disease ◽

Peritoneal Dialysis ◽

Chronic Inflammation ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Treatment Strategies ◽

Dialysis Patients ◽

Lipid Abnormalities ◽

Conventional Risk Factors

Uremia in general and peritoneal dialysis in particular bring with them risk factors for the development of cardiovascular disease. These factors include multiple lipid abnormalities, hyperhomocysteinemia, abdominal obesity, chronic inflammation, hypoalbuminemia, oxidative stress, and AGE formation. When these are combined with conventional risk factors, one can appreciate why the incidence of cardiovascular disease is so high in peritoneal dialysis patients. Treatment strategies should address each of these risks appropriately.

Download Full-text

Increased cardiac troponin T and endothelin-1 concentrations in dialysis patients may indicate heart disease

Nephrology Dialysis Transplantation ◽

10.1093/ndt/14.8.1948 ◽

1999 ◽

Vol 14 (8) ◽

pp. 1948-1955 ◽

Cited By ~ 46

Author(s):

Christian Löwbeer ◽

Astrid Ottosson-Seeberger ◽

Sven A. Gustafsson ◽

Rolf Norrman ◽

Johan Hulting ◽

...

Keyword(s):

Heart Disease ◽

Cardiac Troponin ◽

Troponin T ◽

Cardiac Troponin T ◽

Dialysis Patients ◽

Endothelin 1

Download Full-text

P1881High-sensitivity cardiac troponin T in patients with acute atrial fibrillation

European Heart Journal ◽

10.1093/eurheartj/ehz748.0629 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

R Arbucci ◽

S Haseeb ◽

R Campos ◽

M Trivi ◽

J P Costabel

Keyword(s):

Atrial Fibrillation ◽

Multivariate Analysis ◽

Cardiac Troponin ◽

Cardiovascular Events ◽

Troponin T ◽

Major Adverse Cardiovascular Events ◽

Cardiac Troponin T ◽

Coronary Syndrome ◽

Atrial Area ◽

Af Recurrence

Abstract Background Atrial Fibrillation (AF) is the most common sustained cardiac arrhythmia encountered in clinical practice and confers a significant burden to morbidity and mortality. High-sensitivity cardiac troponin T (hs-cTnT) levels have provided a significant contribution in the early diagnosis of cardiovascular events; however, the significance of hs-cTnT elevation in the setting of acute AF is not clearly understood. Purpose The aim of this study was to evaluate the factors associated with hs-cTnT elevation and its prognostic implication in patients with acute AF. Methods This single-center prospective study included 406 consecutive patients who presented to the emergency department (ED) with acute AF. Acute AF was defined as a rapid, irregular, and chaotic atrial activity of <48 hours' duration including both the first symptomatic onset of chronic or persistent AF, and episodes of paroxysmal AF. The association between hs-cTnT and outcomes were evaluated using multivariate analyses. Results The mean age of the population was 67.3±12.2 and 74% were male. The median time from the onset of symptoms to ED consultation was 230 minutes (interquartile range: 123–450 minutes). The median hs-cTnT value was 12 ng/L, with 39% of patients with values above the 99 thpercentile. AF was reverted to sinus rhythm in 76% of the patients (83% attempted cardioversion). At one-year, AF recurrence was observed in 38% of the patients and major adverse cardiovascular events (MACE) (death, myocardial infarction, acute coronary syndrome or stroke) were observed in 6% of the patients. After adjusting for demographic and clinical characteristics in multivariate analysis, hs-cTnT elevation was associated with increasing age and left atrial area (p=0.001). Hs-cTnT levels were not associated with 1-year AF recurrence (p=0.132) or with AF reversion (p=0.869). Hs-cTnT levels were significantly higher in patients who experienced MACE at 1-year (12 ng/L vs 24 ng/L, p=0.001) and hs-cTnT was a predictor of MACE on multivariate analysis (OR 3.486, 95% CI 1.256–5.379, p=0.009). Variable Result AF rate 110 (90–118) Atrial area, cm2 22 (19–27) Cardioversion attemped 82.5% Conclusions Hs-cTnT elevation accounted for a large proportion of patients with acute AF. Elevated levels of hs-cTnT were not associated with AF reversion or with 1-year AF recurrence, however hs-cTnT was highly predictive of MACE at 1-year.

Download Full-text