Use of cardiac troponin T in diagnosis and prognosis of cardiac events in patients on chronic haemodialysis

Conway, Bryan; McLaughlin, Maureen; Sharpe, Peter; Harty, John

doi:10.1093/ndt/gfi125

Cited by 60 publications

(69 citation statements)

References 17 publications

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“…Results of our investigation confirm that in the absence of an acute coronary event, pre-HD levels of cTnT are commonly increased in patients undergoing chronic HD (up to 60% of the cases) and they are only marginally decreased by HD, since 49% of the patients still have post-HD values above the recommended diagnostic threshold. This is in disagreement with results of previous studies (37,42), which reported a significant rise in cTnT following HD. It should be considered that a variety of confounding factors should not be overlooked when interpreting results of troponin testing in this peculiar clinical setting (37), including the choice of an accurate diagnostic cutoff, the sampling time, and the influence of hemoconcentration.…”

Section: Discussioncontrasting

confidence: 99%

“…This is in disagreement with results of previous studies (37,42), which reported a significant rise in cTnT following HD. It should be considered that a variety of confounding factors should not be overlooked when interpreting results of troponin testing in this peculiar clinical setting (37), including the choice of an accurate diagnostic cutoff, the sampling time, and the influence of hemoconcentration. In the present investigation blood samples were drawn immediately before and 5 min after the end of the HD session.…”

Section: Discussioncontrasting

confidence: 99%

“…Although elevated serum concentrations of cardiac troponins are sensitive and specific markers of myocardial damage in the general population, some earlier studies demonstrated that the baseline levels might be higher than normal in a significant proportion of chronic HD patients without any evidence of acute myocardial injury (37). The influence of impaired renal function and HD on troponin metabolism is hence acknowledged as a major source of diagnostic uncertainty in uremic patients, since both the sensitivity and specificity of this marker might be substantially reduced.…”

Section: Discussionmentioning

confidence: 99%

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Effect of hemodialysis on traditional and innovative cardiac markers

Montagnana

Lippi

Tessitore

et al. 2008

Clinical Laboratory Analysis

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The diagnostic approach to acute coronary syndrome (ACS) is challenging in patients with impaired renal function since most serum biomarkers are commonly increased in this clinical setting. Cardiac troponin T (cTnT), creatine kinase isoenzyme MB (CK MB), myoglobin, and ischemia modified albumin (IMA), were assayed in 45 patients prehemodialysis (pre-HD) and posthemodialysis (post-HD), and results were adjusted for hemoconcentration. The pre-HD values of serum IMA and cTnT were above the respective diagnostic thresholds (IMAo85 K units/L; cTnT o0.03 ng/mL) in six (13%) and 27 (60%) patients undergoing chronic HD, respectively. A significant (105.0 vs. 79.0 K units/L, Po0.0001) and variable (138%; 95% confidence interval [CI], 12-65%) increase of serum IMA was observed post-HD, whereas the other biomarkers significantly decreased (cTnT: 0.029 vs. 0.044 ng/mL, P 5 0.016; CK-MB:2.33 vs.2.50 mg/L, Po 0.0001; myoglobin: 128.1 vs. 148.7 mg/L, Po0.0001). Biomarkers of myocardial injury, especially cTnT and IMA, might be used in HD patients, provided that an appropriate diagnostic interpretation is guarantee, according to individual baseine value, metabolism, and time of sampling. Moreover, IMA might be reliably applied to stratify the long-term risk of these patients, but not for diagnosing an ACS during or immediately post-HD.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Effect of hemodialysis on traditional and innovative cardiac markers

Montagnana

Lippi

Tessitore

et al. 2008

Clinical Laboratory Analysis

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“…The lowest score, signifying no thermal symptoms, was 6, and the highest score, indicating severe symptoms of cold, was 24. The primary end point was the frequency of new LV regional wall motion abnormalities (RWMA) during HD 37 and HD 35 in relation to their effects on BP and systemic hemodynamics. All patients gave informed consent before commencement, and ethical approval for the project was granted by Derbyshire Local Research Ethics Committee.…”

Section: Study Protocolmentioning

confidence: 99%

“…During HD 37 , mean SBP was 141.6 Ϯ 17 mmHg, mean diastolic BP was 69.4 Ϯ 5 mmHg, and mean of the mean arterial pressure (MAP) was 92.6 Ϯ 10 mmHg. During HD 35 , BP was significantly higher: Mean SBP of 158.8 Ϯ 14 mmHg, mean diastolic BP of 78.6 Ϯ 4 mmHg, and mean MAP of 110.9 Ϯ 7 mmHg (P Ͻ 0.001 for all comparisons).…”

Section: Bpmentioning

confidence: 99%

Dialysis-Induced Regional Left Ventricular Dysfunction Is Ameliorated by Cooling the Dialysate

Selby

Burton

Chesterton

et al. 2006

Clinical Journal of the American Society of Nephrology

155

166

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Dialysis patients who develop cardiac failure have a poor prognosis. Recurrent subclinical myocardial ischemia is important in the genesis of heart failure in nondialysis patients. It has previously been demonstrated that subclinical ischemia occurs during hemodialysis; therefore, this study examined whether the improved stability of cool-temperature dialysis lessens this phenomenon. Ten patients who were prone to intradialytic hypotension entered a randomized, crossover study to compare the development of dialysis-induced left ventricular (LV) regional wall motion abnormalities (RWMA) at dialysate temperatures of 37 and 35°C. Serial echocardiography with quantitative analysis was used to assess ejection fraction and regional systolic LV function. BP and hemodynamic variables were measured using continuous pulse wave analysis. The severity of thermal symptoms was scored using a simple questionnaire. Forty-nine new RWMA developed in nine patients during hemodialysis with dialysate at 37°C (HD 37 ), compared with thirteen RWMA that developed in four patients during HD 35 (odds ratio 3.8; 95% confidence interval 2.1 to 6.9). The majority of RWMA displayed improved function by 30 min after dialysis. Overall, regional systolic LV function was significantly more impaired during HD 37 (P < 0.001). BP was higher during HD 35 , with fewer episodes of hypotension as a result of a higher peripheral resistance and no difference in stroke volume. The development of thermal symptoms was heterogeneous, with most patients tolerating HD 35 well. This study confirms previous findings of reversible LV RWMA that develop during hemodialysis. It also shows that this phenomenon can be ameliorated by reducing dialysate temperature, a simple intervention with no cost implications.

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Proteomic profiling reveals comprehensive insights into adrenergic receptor‐mediated hypertrophy in neonatal rat cardiomyocytes

Liu

Zhang

et al. 2009

Proteomics Clinical Apps

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Myocardial adrenergic receptors (ARs) play important roles in cardiac hypertrophy. However, the detailed molecular mechanism of AR-mediated cardiac hypertrophy remains elusive to date. To gain full insight into how ARs are involved in the regulation of cardiac hypertrophy, protein expression profiling was performed with comparative proteomics approach on neonatal rat cardiomyocytes. Forty-six proteins were identified as differentially expressed in hypertrophic cardiomyocytes induced by AR stimulation. To better understand the biological significance of the obtained proteomic data, we utilized the ingenuity pathway analysis tool to construct biological networks and analyze function and pathways that might associate with AR-mediated cardiac hypertrophy. Pathway analysis strongly suggested that ROS may be involved in the development of AR-mediated cardiac hypertrophy, which was then confirmed by further experimentation. The results showed that a marked increase in ROS production was detected in AR-mediated cardiac hypertrophy and blocking of ROS production significantly inhibited AR-mediated cardiac hypertrophy. We further proved that the ROS production was through NADPH oxidase or the mitochondrial electron transport chain and this ROS accumulation resulted in activation of extracellular signal-regulated kinase 1/2 leading to AR-mediated cardiac hypertrophy. These experimental results support the hypothesis, from the ingenuity pathway analysis, that AR-mediated cardiac hypertrophy is associated with the dysregulation of a complicated oxidative stress-regulatory network. In conclusion, our results provide a basis for understanding the detailed molecular mechanisms of AR-mediated cardiac hypertrophy.

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Use of cardiac troponin T in diagnosis and prognosis of cardiac events in patients on chronic haemodialysis

Cited by 60 publications

References 17 publications

Effect of hemodialysis on traditional and innovative cardiac markers

Effect of hemodialysis on traditional and innovative cardiac markers

Dialysis-Induced Regional Left Ventricular Dysfunction Is Ameliorated by Cooling the Dialysate

Proteomic profiling reveals comprehensive insights into adrenergic receptor‐mediated hypertrophy in neonatal rat cardiomyocytes

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