title: Troponin is related to left ventricular mass and predicts all-cause and cardiovascular mortality in hemodialysis patients.
abstract: Cardiac troponin T (cTnT) predicts death and cardiovascular outcomes in clinically stable patients with end-stage renal disease. Because this protein is synthesized exclusively in myocardial cells, its predictive power for these outcomes may be because it reflects, besides cardiac ischemia, left ventricular (LV) mass, which is a strong predictor of cardiovascular death in this population per se. We tested the relationship between cTnT level and LV mass and the predictive power of this cardiac protein for all-cause and cardiovascular mortality in a cohort of hemodialysis patients (n = 199) without acute coronary syndrome and heart failure followed up for an average of 35 months (range, 0.8 to 52 months). cTnT was measured by means of a third-generation electrochemiluminescence immunoassay. cTnT level was related directly to interventricular septum (r = 0.36; P < 0.001) and posterior wall thickness (r = 0.40; P < 0.001), as well as LV mass (r = 0.45; P < 0.001). On multivariate analysis, after age, LV mass was the strongest independent predictor of cTnT level (beta = 0.28; P < 0.001). Serum cTnT level was significantly related to all-cause and cardiovascular mortality on univariate analysis (P < 0.001). On multivariate Cox regression analysis, the adjusted risk for all-cause death was 2.39 times (95% confidence interval [CI], 1.13 to 5.06; P = 0.02) greater in patients in the third cTnT tertile than the first tertile, and a similar pattern emerged for cardiovascular mortality (hazard ratio, 2.35; 95% CI, 1.01 to 5.49; P = 0.048). In hemodialysis patients, plasma cTnT level is independently related to LV mass and predicts all-cause and cardiovascular mortality. These data support the hypothesis that this marker can be usefully applied for risk stratification in clinically stable dialysis patients.
authors.affiliation: Divisione di Nefrologia e CNR, Centro di Fisiologia Clinica, Reggio Calabria, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Mallamaci
authors.forename: Carmine
authors.initials: C
authors.lastname: Zoccali
authors.forename: Saverio
authors.initials: S
authors.lastname: Parlongo
authors.forename: Giovanni
authors.initials: G
authors.lastname: Tripepi
authors.forename: Francesco A
authors.initials: FA
authors.lastname: Benedetto
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Cutrupi
authors.forename: Graziella
authors.initials: G
authors.lastname: Bonanno
authors.forename: Pasquale
authors.initials: P
authors.lastname: Fatuzzo
authors.forename: Francesco
authors.initials: F
authors.lastname: Rapisarda
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Seminara
authors.forename: Benedetta
authors.initials: B
authors.lastname: Stancanelli
authors.forename: Ignazio
authors.initials: I
authors.lastname: Bellanuova
authors.forename: Alessando
authors.initials: A
authors.lastname: Cataliotti
authors.forename: Lorenzo S
authors.initials: LS
authors.lastname: Malatino
mesh_terms: D009202:Cardiomyopathies / Q000401:mortality / Q000503:physiopathology; D002318:Cardiovascular Diseases / Q000401:mortality*; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007118:Immunoassay; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000150:complications / Q000401:mortality / Q000628:therapy*; D016014:Linear Models; D008163:Luminescent Measurements; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000097:blood / Q000401:mortality / Q000503:physiopathology; D011237:Predictive Value of Tests; D012044:Regression Analysis; D006435:Renal Dialysis / Q000401:mortality*; D014336:Troponin / Q000097:blood*; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000503:physiopathology*
chemical_list: D014336:Troponin