Cardiac Troponins in Chronic Kidney Disease: A Marker of Global Cardiovascular Risk

Vaduganathan, Muthiah; Bhatt, Deepak L.

doi:10.1159/000458453

Cited by 5 publications

(4 citation statements)

References 7 publications

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Section: Discussionmentioning

confidence: 99%

“…These have been still a source of debate, but generally accepted theories include underlying asymptomatic heart failure, left ventricular hypertrophy, stable coronary artery disease (CAD), uremia-induced myocardial toxicity, and interdialytic volume overload. [20,21] One systemic review and meta-analysis of 98 cohort studies [22] reported that elevated troponin levels in asymptomatic dialysis patients were at increased risk of cardiovascular mortality and all-cause mortality. To address this issue, the U.S. Food and Drug Administration approved monitoring troponin levels to predict prognosis in this population.…”

Section: Discussionmentioning

confidence: 99%

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Prognostic value of cardiac troponin in dialysis patients with paroxysmal supraventricular tachycardia

et al. 2022

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A rise in cardiac troponin I (cTnI) is common in supraventricular tachycardia (SVT). While troponin elevation in SVT is thought to be a predictor of future adverse events in patients with prior coronary artery disease, the prognostic significance of cTnI in endstage kidney disease (ESKD) patients with SVT are not known. We aimed to examine the prognostic significance of cTnI in ESKD patients presenting with SVT in the emergency department. This was a retrospective, multiple-center observational study utilizing regularly collected electronic medical records. We screened electronic medical records of all dialysis patients presenting to the emergency departments in 5 hospitals over 12 years with SVT. These patients were divided into whether cTnI was tested, and were further stratified into the cTnI-positive and cTnI-negative groups. The primary outcome of the study was the 3-year risk of major adverse cardiovascular events (MACE). Sixty-two patients were qualified for inclusion. Fifty-seven patients (91.9%) were tested for cTnI, and 5 patients were not. Patients with the cTnI test were older (P = .03) and had a longer length of hospital stay (P < .001). Forty-seven patients (82.5%) had a positive result, and 10 (17.5%) had a negative result. A history of hypertension (P = .013) and decreased left ventricular ejection fraction (P = .048) were the independent predictors of cTnI elevation. After a mean follow-up period of 20.6 ± 14.7 months, there were no differences in 3-year MACE between patients with or without elevated cTnI levels in Kaplan-Meier analysis (P = .34). A history of coronary artery disease was the only independent predictor of 3-year MACE (P = .017). Through the subgroup analysis, a history of coronary artery disease (HR 2.73; CI 1.01-7.41; P = .049) remained an independent risk factor for 3-year MACE in patients with elevated cTnI levels. A large proportion (82.5%) of troponin elevation was observed in ESKD patients with SVT, but it had a poor correlation with MACE.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Prognostic value of cardiac troponin in dialysis patients with paroxysmal supraventricular tachycardia

et al. 2022

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“…4,17 Patients with renal insufficiency also have higher baseline troponin levels, making the diagnosis of myocardial infarction more difficult in this population. 18–20 Although the underlying mechanism is not fully understood, elevated levels are likely secondary to reduced renal clearance in addition to comorbid disease conditions associated with troponin release such as severe heart failure and kidney-related anemia. 5 Following a subarachnoid hemorrhage, severe cardiac injury can occur in association with left ventricular systolic dysfunction and pulmonary edema.…”

Section: Discussionmentioning

confidence: 99%

Causes of Troponin Elevation and Associated Mortality in Young Patients

Singh

Collins

et al. 2018

The American Journal of Medicine

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“…The advent of high-sensitive troponin assays enables early detection of acute MI, however, at a cost of false positive diagnoses. Minor troponin elevations are common in a wide variety of medical conditions, such as systemic infection, pulmonary embolism, renal failure, cerebrovascular accident, heart failure, and even after extreme physical stress [3,4,5,6,7,8,9,10]. This multiplicity of causes is problematic in acute care decision-making when the main goal is to detect or rule out type 1 MI as the cause of the ED visit and troponin elevations.…”

Section: Introductionmentioning

confidence: 99%

Etiology of Minor Troponin Elevations in Patients with Atrial Fibrillation at Emergency Department–Tropo-AF Study

Jaakkola

Paana

Nuotio

et al. 2019

JCM

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Patients with atrial fibrillation (AF) presenting to the emergency department (ED) often have elevated cardiac troponin T (TnT) levels without evidence of type 1 myocardial infarction. We sought to explore the causes and significance of minor TnT elevations in patients with AF at the ED. All patients with AF admitted to the ED of Turku University Hospital between 1 March, 2013 and 11 April, 2016, and at least two TnT measurements, were screened. Overall, 2911 patients with a maximum TnT of 100 ng/L during hospitalization were analyzed. TnT was between 15 and 100 ng/L in 2116 patients. The most common primary discharge diagnoses in this group were AF (18.1%), infection (18.3%), ischemic stroke/transient ischemic attack (10.7%), and heart failure (5.0%). Acute coronary syndrome (ACS) was equally uncommon both in patients with normal TnT and elevated TnT (4.4% vs. 4.5%). Age ≥75 years, low estimated glomerular filtration rate (eGFR), high C-reactive protein (CRP), and hemoglobin <10.0 g/dL, were the most important predictors of elevated TnT. Importantly, TnT elevation was a very frequent (>93%) finding in elderly (≥75 years) AF patients with either low eGFR or high CRP. In conclusion, minor TnT elevations carry limited diagnostic value in elderly AF patients with comorbidities.

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Cardiac Troponins in Chronic Kidney Disease: A Marker of Global Cardiovascular Risk

Cited by 5 publications

References 7 publications

Prognostic value of cardiac troponin in dialysis patients with paroxysmal supraventricular tachycardia

Prognostic value of cardiac troponin in dialysis patients with paroxysmal supraventricular tachycardia

Causes of Troponin Elevation and Associated Mortality in Young Patients

Etiology of Minor Troponin Elevations in Patients with Atrial Fibrillation at Emergency Department–Tropo-AF Study

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