title: Troponin T for the detection of dialysis-induced myocardial stunning in hemodialysis patients.
abstract: OBJECTIVE
  Circulating troponin T levels are frequently elevated in patients undergoing long-term dialysis. The pathophysiology underlying these elevations is controversial.
  
  
  METHODS
  In 70 prevalent hemodialysis (HD) patients, HD-induced myocardial stunning was assessed echocardiographically at baseline and after 12 months. Nineteen patients were not available for the follow-up analysis. The extent to which predialysis troponin T was associated with the occurrence of HD-induced myocardial stunning was assessed as the primary endpoint.
  
  
  RESULTS
  The median troponin T level in this hemodialysis cohort was 0.06 ng/ml (interquartile range, 0.02-0.10). At baseline, 64% of patients experienced myocardial stunning. These patients showed significantly higher troponin T levels than patients without stunning (0.08 ng/ml [0.05-0.12] versus 0.02 ng/ml [0.01-0.05]). Troponin T levels were significantly correlated to measures of myocardial stunning severity (number of affected segments: r=0.42; change in ejection fraction from beginning of dialysis to end of dialysis: r=-0.45). In receiver-operating characteristic analyses, predialytic troponin T achieved an area under the curve of 0.82 for the detection of myocardial stunning. In multivariable analysis, only ultrafiltration volume (odds ratio, 4.38 for every additional liter) and troponin T (odds ratio, 9.33 for every additional 0.1 ng/ml) were independently associated with myocardial stunning. After 12 months, nine patients had newly developed myocardial stunning and showed a significant increase in troponin T over baseline (0.03 ng/ml at baseline versus 0.05 ng/ml at year 1).
  
  
  CONCLUSIONS
  Troponin T levels in HD patients are associated with the presence and severity of HD-induced myocardial stunning.
authors: School of Graduate Entry Medicine and Health, University of Nottingham Medical School at Derby and Department of Renal Medicine, Royal Derby Hospital, Derby, United Kingdom. breidthardtt@uhbs.ch
authors: Tobias
authors: T
authors: Breidthardt
authors: James O
authors: JO
authors: Burton
authors: Aghogho
authors: A
authors: Odudu
authors: Mohamed Tarek
authors: MT
authors: Eldehni
authors: Helen J
authors: HJ
authors: Jefferies
authors: Christopher W
authors: CW
authors: McIntyre
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D004739:England; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017682:Myocardial Stunning / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012372:ROC Curve; D006435:Renal Dialysis / Q000009:adverse effects*; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D020107:Troponin T / Q000097:blood*; D014463:Ultrasonography; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; C545568:TNNT2 protein, human; D020107:Troponin T