Cardiac troponin T (cTnT) in hemodialysis patients with asymptomatic and symptomatic atherosclerosis.
BACKGROUND
Cardiovascular mortality is higher in hemodialysis (HD) patients than in the general population. Cardiac troponin T (cTnT) is established as a sensitive marker of myocardial injury in the general population. Less is known about the association between cTnT and intima-media thickness (IMT) and presence of plaques in carotid arteries (asymptomatic atherosclerosis) and prognostic value of cTnT for cardiovascular mortality (symptomatic atherosclerosis) in HD patients.


METHODS
In our study 90 HD patients (mean age 56.2 +/- 13.3 years) were followed after determination of cTnT level. Outcome after 21 months was chosen as the end point. In 52 randomly selected HD patients, IMT was measured with B-mode ultrasonography. Plaque occurrence and their numbers were also determined.


RESULTS
In 24 (26.6%) patients, cTnT values were >0.1 microg/L (positive test for myocardial injury). During follow-up, 13 patients died from cardiovascular causes and their cTnT values were significantly higher (0.12 vs. 0.06 microg/L; p <0.001) than in those who survived. Correlation between cardiovascular mortality and cTnT was found (p <0.001). The cut-off level of 0.1 microg/L resulted in survival rates of 92% and 64% (p=0.0006). The IMT values of carotid artery were significantly higher (0.85 vs. 0.70 mm; p <0.011) in patients with elevated cTnT. All patients with elevated cTnT had plaques and the number of plaques was significantly higher in these patients (p <0.0001).


CONCLUSIONS
cTnT was frequently elevated in our HD patients and was associated with higher cardiovascular mortality and a predictor of cardiovascular outcome. Patients with elevated cTnT showed advanced asymptomatic atherosclerosis in carotid arteries.
Hojs
Radovan
R
Clinical Department of Internal Medicine and Department of Nephrology, University Hospital Maribor, Maribor, Slovenia. Radovan.Hojs@sb-mb.si
Ekart
Robert
R
Hojs Fabjan
Tanja
T
Balon
Breda Pecovnik
BP
Gorenjak
Maksimiljan
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001161:Arteriosclerosis / Q000378:metabolism / Q000473:pathology*; D002318:Cardiovascular Diseases / Q000401:mortality; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism*; D011379:Prognosis; D006435:Renal Dialysis; D013997:Time Factors; D020107:Troponin T / Q000378:metabolism*; D017539:Tunica Intima / Q000473:pathology; D014463:Ultrasonography
D020107:Troponin T