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

Abstract

<b><i>Background:</i></b> Hemodialysis patients, who are often excluded from cardiovascular (CV) clinical trials, are associated with higher CV morbidity and mortality. The risk stratification scheme for these patients is lacking. Therefore, this investigation examined the independent CV prognostic value of high-sensitive cardiac troponin T (hs-cTnT) and added prognostic value over echocardiographic parameters and other clinical risk predictors in asymptomatic stable maintenance hemodialysis (MHD) patients. <b><i>Methods:</i></b> 181 patients with end-stage renal disease undergoing MHD were eligible from the dialysis center of Tongren Hospital, Shanghai Jiao Tong University School of Medicine between October 2017 and September 2018. These patients were followed until September 2020 or until death. The median follow-up was 31 (IQR: 21–33) months. Outcome measures were all-cause mortality, first fatal or nonfatal CV events (CVEs), and 4-point composite major adverse CVEs (MACE). We performed multivariable Cox regression analysis using demographic, clinical, laboratory, and echocardiographic data to identify predictors of CV outcomes. We also evaluated the increased discriminative value associated with the addition of echocardiographic parameters and hs-cTnT using net reclassification improvement (NRI) and integrated discrimination improvement (IDI). <b><i>Results:</i></b> During follow-up, 37 patients died, 84 patients suffered one or more CVEs, and 78 patients developed 4-point MACE. In univariable analyses, age, dialysis vintage, diastolic blood pressure, parathyroid hormone concentrations, hs-cTnT, B-type natriuretic peptide, left ventricular mass index (LVMI), and <i>E</i>/<i>E</i>′ predicted all end points. hs-cTnT remained a strong predictor for each end point in multivariate analysis, whereas LVMI and <i>E</i>/<i>E</i>′ did not. The addition of hs-cTnT on top of clinical and echocardiographic variables was associated with improvements in reclassification for CVEs (NRI = 44.6% [15.9–74.3%], IDI = 15.9% [5.7–31.0%], all <i>p</i> < 0.001), all-cause mortality (NRI = 35.5% [10.1–50.2%], <i>p</i> < 0.001, IDI = 4.4% [1.3–8.5%], <i>p</i> = 0.005), and 4-point MACE (NRI = 47.2% [16.1–64.9%], <i>p</i> < 0.001, IDI = 16.9% [5.5–37.3%], <i>p</i> = 0.005). Adding echocardiographic variables on top of clinical variables and hs-cTnT was not associated with significant improvements in NRI and IDI (all <i>p</i> > 0.05). <b><i>Conclusions:</i></b> Our data suggest that hs-cTnT is a powerful independent predictor of CV outcome and all-cause mortality in stable MHD patients. The additional use of echocardiography for improvement of risk stratification is not supported by our results.

Long‐term predialysis blood pressure variability and outcomes in hemodialysis patients

“…6,15 The ventricular arrhythmias included ventricular tachycardia, ventricular fibrillation, and II-or III-degree atrioventricular block. 16 Patients were censored at the time of an event of interest occurred.…”

“…The second outcome was MACE, a composite of fatal cardiovascular event, nonfatal myocardial infarction, nonfatal stroke, ventricular arrhythmias and limb amputation because of peripheral vascular disease 6,15 . The ventricular arrhythmias included ventricular tachycardia, ventricular fibrillation, and II‐ or III‐degree atrioventricular block 16 . Patients were censored at the time of an event of interest occurred.…”

The use of high-sensitivity cardiac troponin T and creatinine kinase-MB as a prognostic markers in patients with acute myocardial infarction and chronic kidney disease

“…Several studies have demonstrated that they predict immediate and long-term mortality in AMI and are associated with coronary lesion severity and infarct size [ 5–8 ]. Hs-cTnT was found to be elevated in patients with CKD without myocardial infarction and was associated with poor prognosis, indicating that renal insufficiency is a factor contributing to troponin elevation [ 9 , 10 ]. The optimal cutoff value for hs-cTnT to diagnose AMI varies at different stages of CKD, and generally increases as eGRF decreases [ 11 , 12 ].…”