Cardiac Structural and Functional Abnormalities in End Stage Renal Disease Patients with Elevated Cardiac Troponin T

Overview

Journal Heart

Date 2005 Oct 12

PMID 16216854

Citations 28

Authors

R Sharma

D C Gaze

D Pellerin

R L Mehta

H Gregson

C P Streather

P O Collinson

S J D Brecker

Affiliations

Soon will be listed here.

Abstract

Objectives: To identify in a prospective observational study the cardiac structural and functional abnormalities and mortality in patients with end stage renal disease (ESRD) with a raised cardiac troponin T (cTnT) concentration.

Methods: 126 renal transplant candidates were studied over a two year period. Clinical, biochemical, echocardiographic, coronary angiographic, and dobutamine stress echocardiographic (DSE) data were examined in comparison with cTnT concentrations dichotomised at cut off concentrations of < 0.04 microg/l and < 0.10 microg/l.

Results: Left ventricular (LV) size and filling pressure were significantly raised and LV systolic and diastolic function parameters significantly impaired in patients with raised cTnT, irrespective of the cut off concentration. The proportions of patients with diabetes and on dialysis were higher in both groups with raised cTnT. With a cut off cTnT concentration of 0.04 microg/l but not 0.10 microg/l, significantly more patients had severe coronary artery disease and a positive DSE result. The total ischaemic burden during DSE was similar in cTnT positive and negative patients, irrespective of the cut off concentration used. LV end systolic diameter index and E:Ea ratio were independent predictors of cTnT rises > or = 0.04 microg/l and > or = 0.10 microg/l, respectively. Diabetes was independently associated with cTnT at both cut off concentrations. Mortality was higher in all patients with raised cTnT.

Conclusions: Patients with ESRD with raised cTnT concentrations have increased mortality. Raised concentrations are strongly associated with diabetes, LV dilatation, and impaired LV systolic and diastolic function, but not with severe coronary artery disease.

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References

Foley R, Parfrey P, Harnett J, Kent G, Martin C, Murray D . Clinical and echocardiographic disease in patients starting end-stage renal disease therapy. Kidney Int. 1995; 47(1):186-92. DOI: 10.1038/ki.1995.22. View

deFilippi C, Fink J, Nass C, Chen H, Christenson R . N-terminal pro-B-type natriuretic peptide for predicting coronary disease and left ventricular hypertrophy in asymptomatic CKD not requiring dialysis. Am J Kidney Dis. 2005; 46(1):35-44. DOI: 10.1053/j.ajkd.2005.04.007. View

Sohn D, Chai I, Lee D, Kim H, Kim H, Oh B . Assessment of mitral annulus velocity by Doppler tissue imaging in the evaluation of left ventricular diastolic function. J Am Coll Cardiol. 1997; 30(2):474-80. DOI: 10.1016/s0735-1097(97)88335-0. View

McGregor E, Jardine A, Murray L, Dargie H, Rodger R, Junor B . Pre-operative echocardiographic abnormalities and adverse outcome following renal transplantation. Nephrol Dial Transplant. 1998; 13(6):1499-505. DOI: 10.1093/ndt/13.6.1499. View

Foley R, Parfrey P, Sarnak M . Clinical epidemiology of cardiovascular disease in chronic renal disease. Am J Kidney Dis. 1998; 32(5 Suppl 3):S112-9. DOI: 10.1053/ajkd.1998.v32.pm9820470. View

Hallermayer K, Klenner D, Vogel R . Use of recombinant human cardiac Troponin T for standardization of third generation Troponin T methods. Scand J Clin Lab Invest Suppl. 1999; 230:128-31. View

deFilippi C, Wasserman S, Rosanio S, Tiblier E, Sperger H, Tocchi M . Cardiac troponin T and C-reactive protein for predicting prognosis, coronary atherosclerosis, and cardiomyopathy in patients undergoing long-term hemodialysis. JAMA. 2003; 290(3):353-9. DOI: 10.1001/jama.290.3.353. View

Diris J, Hackeng C, Kooman J, Pinto Y, Hermens W, van Dieijen-Visser M . Impaired renal clearance explains elevated troponin T fragments in hemodialysis patients. Circulation. 2003; 109(1):23-5. DOI: 10.1161/01.CIR.0000109483.45211.8F. View

Nielsen L, Svanegaard J, Klitgaard N, Egeblad H . N-terminal pro-brain natriuretic peptide for discriminating between cardiac and non-cardiac dyspnoea. Eur J Heart Fail. 2004; 6(1):63-70. DOI: 10.1016/j.ejheart.2003.10.003. View

10.

Giannitsis E, Katus H . Troponin T release in hemodialysis patients. Circulation. 2004; 110(3):e25-6. DOI: 10.1161/01.CIR.0000135543.93270.D2. View

11.

Jeon D, Lee M, Kim C, Cho J, Moon K, Kim B . Clinical findings in patients with cardiac troponin T elevation and end-stage renal disease without acute coronary syndrome. Am J Cardiol. 2004; 94(6):831-4. DOI: 10.1016/j.amjcard.2004.05.074. View

12.

Obialo C, Sharda S, Goyal S, Ofili E, Oduwole A, Gray N . Ability of troponin T to predict angiographic coronary artery disease in patients with chronic kidney disease. Am J Cardiol. 2004; 94(6):834-6. DOI: 10.1016/j.amjcard.2004.05.075. View

13.

Devereux R, Reichek N . Echocardiographic determination of left ventricular mass in man. Anatomic validation of the method. Circulation. 1977; 55(4):613-8. DOI: 10.1161/01.cir.55.4.613. View

14.

Deckert T, Poulsen J, Larsen M . Prognosis of diabetics with diabetes onset before the age of thirty-one. I. Survival, causes of death, and complications. Diabetologia. 1978; 14(6):363-70. DOI: 10.1007/BF01228130. View

15.

Silberberg J, Barre P, Prichard S, Sniderman A . Impact of left ventricular hypertrophy on survival in end-stage renal disease. Kidney Int. 1989; 36(2):286-90. DOI: 10.1038/ki.1989.192. View

16.

Schiller N, Shah P, Crawford M, DeMaria A, Devereux R, FEIGENBAUM H . Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. J Am Soc Echocardiogr. 1989; 2(5):358-67. DOI: 10.1016/s0894-7317(89)80014-8. View

17.

Armstrong W . Stress echocardiography for detection of coronary artery disease. Circulation. 1991; 84(3 Suppl):I43-9. View

18.

Ooi D, Isotalo P, Veinot J . Correlation of antemortem serum creatine kinase, creatine kinase-MB, troponin I, and troponin T with cardiac pathology. Clin Chem. 2000; 46(3):338-44. View

19.

Amann K, Buzello M, Simonaviciene A, Miltenberger-Miltenyi G, Koch A, Nabokov A . Capillary/myocyte mismatch in the heart in renal failure--a role for erythropoietin?. Nephrol Dial Transplant. 2000; 15(7):964-9. DOI: 10.1093/ndt/15.7.964. View

20.

Ommen S, Nishimura R, Appleton C, Miller F, Oh J, Redfield M . Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures: A comparative simultaneous Doppler-catheterization study. Circulation. 2000; 102(15):1788-94. DOI: 10.1161/01.cir.102.15.1788. View