Cardiac Troponin T: Smaller Molecules in Patients with End-Stage Renal Disease than after Onset of Acute Myocardial Infarction

Mingels, Alma M.A.; Cardinaels, Eline P.M.; Broers, Natascha J. H.; Sleeuwen, Anneke van; Streng, Alexander S.; Dieijen-Visser, Marja P. van; Kooman, Jeroen P.; Bekers, Otto

doi:10.1373/clinchem.2016.261644

Cited by 61 publications

(42 citation statements)

References 29 publications

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“…Indeed, after myocardial infarction, cTnT and cTnI have been observed as free cTnT and cTnI, larger cTnT-I-C (77 kDa) and cTnI-C (40 kDa) complexes, and fragments (27)(28)(29)(30)(31). In contrast, in renal failure, cTnT circulates primarily as fragments (32 ), whereas the circulating form of cTnI in renal failure is unknown.…”

Section: Discussionmentioning

confidence: 98%

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Estimated Glomerular Filtration Rate and Albuminuria Are Associated with Biomarkers of Cardiac Injury in a Population-Based Cohort Study: The Maastricht Study

et al. 2017

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BACKGROUND Chronic kidney disease (CKD) is associated with an increased cardiovascular disease mortality risk. It is, however, less clear at what point in the course from normal kidney function to CKD the association with cardiovascular disease appears. Studying the associations of estimated glomerular filtration rate (eGFR) and albuminuria with biomarkers of (subclinical) cardiac injury in a population without substantial CKD may clarify this issue. METHODS We examined the cross-sectional associations of eGFR and urinary albumin excretion (UAE) with high-sensitivity cardiac troponin (hs-cTn) T, hs-cTnI, and N-terminal probrain natriuretic-peptide (NT-proBNP) in 3103 individuals from a population-based diabetes-enriched cohort study. RESULTS After adjustment for potential confounders, eGFR and UAE were associated with these biomarkers of cardiac injury, even at levels that do not fulfill the CKD criteria. For example, eGFR 60–<90 mL · min−1 ·(1.73 m2)−1 [vs ≥90 mL · min−1 · (1.73 m2)−1] was associated with a [ratio (95% CI)] 1.21 (1.17–1.26), 1.14 (1.07–1.20), and 1.19 (1.12–1.27) times higher hs-cTnT, hs-cTnI, and NT-proBNP, respectively. The association of eGFR with hs-cTnT was statistically significantly stronger than that with hs-cTnI. In addition, UAE 15–<30 mg/24 h (vs <15 mg/24 h) was associated with a 1.04 (0.98–1.10), 1.08 (1.00–1.18), and 1.07 (0.96–1.18) times higher hs-cTnT, hs-cTnI, and NT-proBNP, respectively. CONCLUSIONS eGFR and albuminuria were already associated with biomarkers of (subclinical) cardiac injury at levels that do not fulfill the CKD criteria. Although reduced renal elimination may partly underlie the associations of eGFR, these findings support the concept that eGFR and albuminuria are, over their entire range, associated with cardiac injury.

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Section: Discussionmentioning

confidence: 98%

“…Differences in renal elimination between both cTn, for example accumulation of cTnT fragments (32 ), may explain their differential association with eGFR (15 ). However, other explanations should also be considered.…”

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confidence: 99%

Estimated Glomerular Filtration Rate and Albuminuria Are Associated with Biomarkers of Cardiac Injury in a Population-Based Cohort Study: The Maastricht Study

et al. 2017

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“…Clinically, increased hs-cTnT is observed in many asymptomatic renal insufficiency patients with normal ECGs 9,10 , which may be related to minimal myocardial injury and a decreased estimated glomerular filtration rate (eGFR) 11 .Study found that cTnT forms in ESRD patients are small (<18 kDa) and different from forms seen in AMI patients 12 , however, the current test can not distinguish them. Because this test is also affected by renal function, however, it cannot be an effective marker to measure the degree of myocardial injury.…”

Section: Introductionmentioning

confidence: 61%

Diagnostic value of the Hs-cTnT/CysC ratio in patients with stage ≥3 CKD and acute myocardial infarction

Liu

Cai

Lin

et al. 2020

Preprint

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Background: We investigated the diagnostic value of the ratio of high sensitivity troponin to cystatin C in CKD patients with stage ≥ 3 chronic kidney disease (CKD) and acute myocardial infarction. Methods: We retrospectively analyzed 401 patients with suspected acute myocardial infarction (AMI) who underwent coronary angiography in the chest pain center at our hospital during 2013–2019. Among the 196 patients studied, 113 were placed in an AMI group and 83 in a non-AMI group. Results: There were no significant differences in age, sex, or the presence of hypertension, diabetes, gout/hyperuricemia, stroke, tumor, or epidermal growth factor receptors between the two groups (P > 0.05). A correlation analysis showed that there was a positive correlation between CysC and Cr, with a correlation coefficient of 0.872 (P < 0.001). A receiver operating characteristic curve for the high-sensitivity cardiac troponin T (hs-cTnT)/CysC ratio showed an area under the curve value of 0.925 (P < 0.001), with sensitivity of 78.4% and specificity of 94.0%. Conclusion: The hs-TnT/CysC ratio can thus be used as an index to predict AMI in patients with stage≥ 3 CKD.

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“…However, studies on both older assays and hs-cTn assays have shown that almost all circulating cTnT molecules in patients with ESRD are degraded into smaller fragments (<20 kDa), small enough for glomerular filtration (102)(103)(104). Recent findings indicate that only intact cTnT and larger primary fragments demonstrate hs-cTnT assay immunoreactivity in patients with MI, which differs from a pattern of immunoreactive small cTnT fragments found in patients with ESRD (103). These observations suggest a principal extrarenal clearance mechanism, conceivably by scavenger receptor-mediated endocytosis in the mononuclear phagocyte system, at high cTnT concentrations e.g.…”

Section: Chronic Myocardial Injury and Renal Functionmentioning

confidence: 99%

Diurnal variation in admission troponin concentrations in patients with chest pain in the emergency department

Roos

Holzmann

2018

Clinical Biochemistry

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Cardiac Troponin T: Smaller Molecules in Patients with End-Stage Renal Disease than after Onset of Acute Myocardial Infarction

Abstract: We found that cTnT forms in ESRD patients are small (<18 kDa) and different from forms seen in AMI patients. These insights may prove useful for development of a more specific cTnT immunoassay, especially for the acute and diagnostic phase of myocardial infarction.

Cited by 61 publications

References 29 publications

Estimated Glomerular Filtration Rate and Albuminuria Are Associated with Biomarkers of Cardiac Injury in a Population-Based Cohort Study: The Maastricht Study

Estimated Glomerular Filtration Rate and Albuminuria Are Associated with Biomarkers of Cardiac Injury in a Population-Based Cohort Study: The Maastricht Study

Diagnostic value of the Hs-cTnT/CysC ratio in patients with stage ≥3 CKD and acute myocardial infarction

Diurnal variation in admission troponin concentrations in patients with chest pain in the emergency department

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