scholarly journals Cardiac Troponin T Circulates in the Free, Intact Form in Patients with Kidney Failure

2006 ◽  
Vol 52 (3) ◽  
pp. 414-420 ◽  
Author(s):  
Michael N Fahie-Wilson ◽  
David J Carmichael ◽  
Michael P Delaney ◽  
Paul E Stevens ◽  
Elizabeth M Hall ◽  
...  
Keyword(s):  
Molecular Mass ◽  
Kidney Failure ◽  
Cardiac Troponin ◽  
Troponin T ◽  
Gel Filtration ◽  
Serum Prolactin ◽  
Relative Molecular Mass ◽  
Cardiac Troponin T ◽  
Coronary Syndrome ◽  
Esrd Patients

Abstract Background: The clinical significance of the increased concentrations of cardiac troponins observed in patients with end stage renal disease (ESRD) in the absence of an acute coronary syndrome (ACS) is controversial. One proposed explanation is that immunoreactive fragments of cardiac troponin T (cTnT) accumulate in ESRD. We used gel-filtration chromatography (GFC) to ascertain whether fragments of cTnT, which could cross-react in the commercial diagnostic immunoassay (Roche Diagnostics), were the cause of the increased cTnT in the serum of patients with ESRD. Methods: We subjected sera from ESRD patients (n = 21) receiving dialysis and having increased cTnT concentrations to size-separation GFC. We detected cTnT in the chromatography fractions by use of the same antibodies used in the commercial assay for serum cTnT. Results: In all patients, cTnT immunoreactivity eluted as a major, homogeneous peak in an identical position between the peaks of serum prolactin [relative molecular mass (Mr) 23 000] and albumin (Mr 67 000): the elution pattern of cTnT in samples obtained from ACS patients was identical to that of the ESRD patients. There was no evidence that low–molecular-mass (Mr <23 000) cTnT fragments were the cause of the increased cTnT in the patients studied. Conclusions: The form of cTnT observed in the serum of patients with kidney failure and immunoreactive in the diagnostic assay is predominantly the free intact form, as in patients with ACS. Our data are consistent with the view that circulating cTnT in renal failure reflects cardiac pathology.

scholarly journals Elevation of Highly Sensitive Cardiac Troponin T Among End-Stage Renal Disease Patients Without Acute Coronary Syndrome

2021 ◽  
Vol 28 (5) ◽  
pp. 64-71
Author(s):  
Wan Nur Aimi Wan Mohd Zamri ◽  
◽  
Noorazliyana Shafii ◽  
Tuan Salwani Tuan Ismail ◽  
Adlin Zafrulan Zakaria ◽  
...  
Keyword(s):  
End Stage Renal Disease ◽  
Cardiac Troponin ◽  
Troponin T ◽  
Cardiac Troponin T ◽  
Coronary Syndrome ◽  
Highly Sensitive ◽  
Stage Renal Disease ◽  
End Stage ◽  
Study Participants ◽  
Esrd Patients

Background: In end-stage renal disease (ESRD), troponin T concentrations can be elevated even without cardiac ischaemia, which hampers the diagnosis of acute myocardial infarction (AMI). The objectives of our study were to determine the proportion of dialysisdependent ESRD patients without acute coronary syndrome (ACS) but with highly sensitive cardiac troponin T (hs-cTnT) levels above the 99th percentile upper reference limit and to evaluate the range of hs-cTnT among this population. Methods: A cross-sectional study was conducted at the haemodialysis (HD) unit of a tertiary hospital in Malaysia from January 2018 to February 2019. Dialysis-dependent ESRD patients were included and those with a recent history of ACS (within 30 days) were excluded. Pre-dialysed serum hs-cTnT levels were measured using Cobas e411. The upper limit of the 99th percentile value for troponin T was 14 ng/L. Results: A total of 150 patients were recruited as study participants. The majority were female (62%) and of Malay ethnicity (94%), and the mean (SD) age was 45.19 (16.36) years old. The hs-cTnT range (min, max) was 11.39–738.30 ng/L and the median (interquartile range [IQR]) of hs-cTnT was 59.20 (83.41) ng/L. Elevated hs-cTnT levels were observed in 149/150 (99%) of the study participants (54/55 [98.2%] of the patients were on HD, and 95/95 [100.0%] of the patients were on continuous ambulatory peritoneal dialysis). Conclusion: This study supports prior research showing that even without ACS, most ESRD patients have elevated concentrations of cardiac troponin. Furthermore, our study illustrates the need to revisit the use of absolute troponin values when making a diagnosis of ACS in ESRD patients.

scholarly journals Effect of Hemodialysis, Coronary Artery Disease and Diabetes on Cardiac Troponin T: A Prospective Survey Over One Year

2009 ◽  
Vol 3 (1) ◽  
pp. 69-77 ◽  
Author(s):  
François-Pierre Mongeon ◽  
Marc Dorais ◽  
Jacques Le Lorier ◽  
Daniel Froment ◽  
Élaine Letendre ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Cardiac Troponin ◽  
Troponin T ◽  
Diabetic Patients ◽  
Cardiac Troponin T ◽  
Coronary Syndrome ◽  
Before And After ◽  
Artery Disease ◽  
Esrd Patients

Background:Limited data is available about the effects of hemodialysis sessions, coronary artery disease (CAD), and diabetes on serum cardiac troponin T (cTnT) levels in patients with end-stage renal disease (ESRD).Objectives:To test whether hemodialysis could be associated with an increase in cTnT concentration. To evaluate if coronary artery disease (CAD) or diabetes are associated with higher cTnT levels in ESRD.Methods:Serum cTnT levels were measured immediately before and after dialysis 3 times over 1 year (0, 6, and 12 months).Results:A total of 100 ESRD patients without acute coronary syndrome (mean age of 58.5 years, 34% with diabetes, and 37% with CAD) gave 267 pre-dialysis and 260 post-dialysis blood samples. The mean (standard deviation) pre-dialysis cTnT levels were 0.06 (0.12), 0.05 (0.06), and 0.07 (0.07) mcg/L at 0, 6, and 12 months, respectively. The post-dialysis cTnT levels were similar on average. Among 259 samples with cTnT measured both before and after dialysis, 79 (30.5%) showed a decrease in serum cTnT, 97 (37.5%) showed an increase and 83 (32%) showed no change following dialysis. Mean cTnT was higher in CAD than in non-CAD patients. We observed no significant difference in mean cTnT levels between diabetic and non-diabetic patients.Conclusions:cTnT levels were not affected by individual hemodialysis sessions, and remained stable around 0.06 mcg/L over a 1-year period in ESRD patients. Random cTnT levels were higher in stable CAD patients undergoing hemodialysis.

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

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.

scholarly journals Clinical Significance of Increased Cardiac Troponin T in Patients with Chronic Hemodialysis and Cardiovascular Disease: Comparison to B-Type Natriuretic Peptide and A-Type Natriuretic Peptide Increase

2019 ◽  
Vol 44 (5) ◽  
pp. 1050-1062 ◽  
Author(s):  
Shinichiro Niizuma ◽  
Yoshitaka Iwanaga ◽  
Takehiko Washio ◽  
Tadashi Ashida ◽  
Shinsuke Harasawa ◽  
...  
Keyword(s):  
Natriuretic Peptide ◽  
Cardiac Troponin ◽  
Diastolic Pressure ◽  
Troponin T ◽  
Left Ventricular ◽  
Chronic Hemodialysis ◽  
Cardiac Troponin T ◽  
Vascular Events ◽  
Coronary Syndrome ◽  
Artery Disease

Background: An increased cardiac troponin T (cTnT) level identifies a high-risk group in patients with end-stage renal disease; however, the mechanism of cTnT elevation remains unclear in such patients without acute coronary syndrome (ACS). Therefore, we explored the relationship between cTnT levels and the hemodynamic parameters and the prognostic potential of cTnT in stable patients with chronic hemodialysis (HD). Methods: We included consecutive 174 patients with HD who were referred for coronary angiography due to stable coronary artery disease (CAD), peripheral artery disease (PAD), or heart failure (HF). Hemodynamic measurement was performed, and plasma cTnT, B-type natriuretic peptide (BNP), and A-type natriuretic peptide (ANP) were measured at the same time. The potential of 3 biomarkers to predict all-cause mortality, cardiac death or hospitalized HF, and vascular event was assessed. Results: Increased log cTnT levels were correlated with increased log BNP and log ANP levels (r = 0.531, p < 0.001 and r = 0.411, p < 0.001, respectively). Not increased log cTnT, but increased log BNP and log ANP were associated with the presence of CAD and the extent of CAD. In contrast, they were all associated with the New York Heart Association functional classification and the presence of PAD and significantly correlated with left ventricular end-diastolic pressure (LVEDP) in an independent manner. Increased cTnT and BNP levels were associated with the mortality and hospitalized HF. However, increased cTnT was not associated with vascular events, unlike increased BNP. Conclusions: In patients with chronic HD without ACS, increased cTnT reflected increased LVEDP and the presence of HF or PAD independently, and it did not reflect the presence of CAD in contrast to increased BNP. cTnT and BNP were significant prognostic predictors; however, increased cTnT was associated with HF-related events, not with arteriosclerotic events.

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