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

Abstract

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.

High-Sensitive Cardiac Troponin T for Prediction of Cardiovascular Outcomes in Stable Maintenance Hemodialysis Patients: A 3-Year Prospective Study

“…In our study, there were about 93% of patients with hs-cTnT levels above the 99th percentile upper reference limit (14 pg/mL) which was consistent with the literature reports [12, 13]. Several studies have shown cTnT to be a strong predictor of cardiac events in hemodialysis patients [5, 15, 16]. However, some conflicting results have been reported.…”

Obscurin and Clusterin Elevation in Serum of Acute Myocardial Infarction Patients

“…[28][29][30][31][32][33][34][35][36][37][38] Transthyretin, hemoglobin subunit alpha, beta, antithrombin III, serum amyloid P-component, fibrinogen α, ß, γ, alpha-1-acid glycoprotein 1 and 2, apolipoprotein A-II, and serotransferrin are relatively highly abundant proteins in human serum and therefore already known biomarkers for cancer, inflammation, cardiac hypertrophy, and heart failure. [28][29][30][31][32][33][34][35][36][39][40][41] Some proteins are known as muscle or cardiac muscle components, such as complement C-4A, C3, obscurin, and titin. 34,35,39,40 We calculated point for screened biomarker candidates with three criteria: First, qualitatively identified number of cases.…”

“…BNP was not significantly elevated (p = 0.113) in AMI samples according to t-test. BNP is a recognized biomarker for heart failure, and therefore its elevation may not be significant in AMI patients; moreover, its mechanism of secretion may differ from the troponin T. 41 The significance of titin elevation was at the border line of judgment (p = 0.068). The elevation of fibrinogen beta and antithrombin III was not statistically significant (shown in Table 3).…”

“…Twelve proteins among 23 were reported with acute inflammation, heart failure, thrombosis, and cardiac diseases . Transthyretin, hemoglobin subunit alpha, beta, antithrombin III, serum amyloid P‐component, fibrinogen α, ß, γ, alpha‐1‐acid glycoprotein 1 and 2, apolipoprotein A‐II, and serotransferrin are relatively highly abundant proteins in human serum and therefore already known biomarkers for cancer, inflammation, cardiac hypertrophy, and heart failure . Some proteins are known as muscle or cardiac muscle components, such as complement C‐4A, C3, obscurin, and titin …”

Cardiovascular Consequences of Acute Kidney Injury

“…58 Levels of cardiac troponin, a biomarker for myocardial injury, are frequently elevated in patients with renal dysfunction -specifically, in 30 to 75% of patients receiving hemodialysis. 59 Since plasma troponin levels can be affected by both cardiac injury and decreased renal clearance, a single measurement may be insufficient to diagnose acute cardiac ischemia. In our view, the clinical presentation, electrocardiographic findings, and kinetics of troponin are all important to consider in the diagnosis of an acute coronary syndrome in patients with acute kidney injury.…”