Cardiac troponins in renal insufficiency: review and clinical implications.

Background Among patients with suspected acute coronary syndromes, cardiac troponin T levels have prognostic value. However, there is concern that renal dysfunction may impair the prognostic value, because cardiac troponin T may be cleared by the kidney. Methods We analyzed the outcomes in 7033 patients enrolled in the Global Use of Strategies to Open Occluded Coronary Arteries IV trial who had complete base-line data on troponin T levels and creatinine clearance rates. The troponin T level was considered abnormal if it was 0.1 ng per milliliter or higher, and creatinine clearance was assessed in quartiles. The primary end point was a composite of death or myocardial infarction within 30 days. Results Death or myocardial infarction occurred in 581 patients. Among patients with a creatinine clearance above the 25th percentile value of 58.4 ml per minute, an abnormally elevated troponin T level was predictive of an increased risk of myocardial infarction or death (7 percent vs. 5 percent; adjusted odds rati...

https://www.nejm.org/doi/pdf/10.1056/NEJMoa013456

Troponin T Levels in Patients with Acute Coronary Syndromes, with or without Renal Dysfunction

The cardiac troponins form part of the regulatory mechanism for muscle contraction. Specific cardiac isoforms of cardiac troponin T and cardiac troponin I exist and commercially available immunoassay systems have been developed for their measurement. A large number of clinical and analytical studies have been performed and the measurement of cardiac troponins is now considered the 'gold standard' biochemical test for diagnosis of myocardial damage. There have been advances in understanding the development and structure of troponins and their degradation following myocardial cell necrosis. This has contributed to the understanding of the problems with current assays. Greater clinical use has also highlighted areas of analytical and clinical confusion. The assays are reviewed based on manufacturers' information, current published material as well as the authors' in-house experience.

https://journals.sagepub.com/doi/pdf/10.1177/000456320103800501

Measurement of Cardiac Troponins

Background Clinicians face uncertainty about the prognostic value of troponin testing in patients with chronic kidney disease (CKD) without suspected acute coronary syndrome (ACS). Purpose To systematically review the literature on troponin testing in patients with CKD without ACS. Data sources MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials through May 2014. Study selection Studies examining elevated versus normal troponin levels in patients with CKD without ACS. Data extraction Paired reviewers selected articles for inclusion, extracted data, and graded strength of evidence (SOE). Meta-analyses were conducted when studies had sufficient homogeneity of key variables. Data synthesis Ninety-eight studies met inclusion criteria. Elevated troponin levels were associated with all-cause and cardiovascular mortality among patients receiving dialysis (moderate SOE). Pooled hazard ratios (HRs) for all-cause mortality from studies that adjusted for age and coronary artery disease or a risk equivalent were 3.0 (95% CI, 2.4 to 4.3) for troponin T and 2.7 (CI, 1.9 to 4.6) for troponin I. The pooled adjusted HRs for cardiovascular mortality were 3.3 (CI, 1.8 to 5.4) for troponin T and 4.2 (CI, 2.0 to 9.2) for troponin I. Findings were similar for patients with CKD who were not receiving dialysis, but there were fewer studies. No study tested treatment strategies by troponin cut points. Limitation Studies were heterogeneous regarding assays, troponin cut points, covariate adjustment, and follow-up. Conclusion In patients with CKD without suspected ACS, elevated troponin levels were associated with worse prognosis. Future studies should focus on whether this biomarker is more appropriate than clinical models for reclassifying risk of patients with CKD and whether such classification can help guide treatment in those at highest risk for death. Primary funding source Agency for Healthcare Research and Quality.

Prognostic Value of Cardiac Troponin in Patients With Chronic Kidney Disease Without Suspected Acute Coronary Syndrome: A Systematic Review and Meta-analysis

Background. Serum concentrations of the cardiac troponins (cTn) T and I, specific markers of myocardial injury, are frequently elevated in haemodialysis patients. The clinical relevance of this is unclear. The aim of this study was to investigate factors associated with increased serum levels of cTn in haemodialysis patients. Methods. We included in this cross-sectional study 258 chronic haemodialysis patients (150 men, age 60±15 years) without acute coronary symptoms. Clinical data, echocardiographic hypertrophy, biochemical status, and haemodialysis regimen were evaluated for each patient. Pre-dialysis serum cTnT (Elecsys, Roche), cTnI (Stratus and RXL, Dade-Berhing), and CK-MB (Stratus, Dade- Berhing) concentrations were determined. Logistic regression was the principal method of analysis. Results. Pre-dialysis levels of cTnT > 0.1 ng/ml (n = 48. 18.6% of patients) were associated with age (P 0.6 ng/ml. cTnI-RXL levels >0.3 ng/ml (n = 13, 5.0%) were associated with age (P = 0.05) and hyper-cholesterolaemia (P < 0.05). Only age (OR 1.06) remained associated in multivariate analysis. Conclusion. Elevated baseline serum levels of cardiac troponins were associated with cardiovascular risk factors, history of ischaemic heart disease and left ventricular hypertrophy in asymptomatic chronic haemodialysis patients.

/pdf/factors-associated-with-increased-serum-levels-of-cardiac-3myowr274z.pdf

Factors associated with increased serum levels of cardiac troponins T and I in chronic haemodialysis patients: Chronic Haemodialysis And New Cardiac Markers Evaluation (CHANCE) study

https://www.ajkd.org/article/S0272-6386(97)90201-8/pdf

Prognostic value of serum cardiac troponin I and T in chronic dialysis patients: A 1-year outcomes analysis

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Prognostic value of serum cardiac troponin I and T in chronic dialysis patients: A 1-year outcomes analysis