title: Serum Cardiac Troponin-I is Superior to Troponin-T as a Marker for Left Ventricular Dysfunction in Clinically Stable Patients with End-Stage Renal Disease.
abstract: BACKGROUND
  Serum troponin assays, widely used to detect acute cardiac ischemia, might be useful biomarkers to detect chronic cardiovascular disease (CVD). Cardiac-specific troponin-I (cTnI) and troponin-T (cTnT) generally detect myocardial necrosis equally well. In dialysis patients however, serum cTnT levels are often elevated, unlike cTnI levels. The present study aims to elucidate the associations of cTnI and cTnT with CVD in clinically stable dialysis patients.
  
  
  METHODS
  Troponin levels were measured using 5th generation hs-cTnT assays (Roche) and STAT hs-cTnI assays (Abbott) in a cohort of dialysis patients. Serum troponin levels were divided into tertiles with the lowest tertile as a reference value. Serum troponins were associated with indicators of CVD such as left ventricular mass index (LVMI), left ventricular ejection fraction (LVEF) and the presence of coronary artery disease (CAD). Associations were explored using regression analysis.
  
  
  RESULTS
  We included 154 consecutive patients, 68±7 years old, 77% male, 70% hemodialysis. Median serum cTnT was 51ng/L (exceeding the 99th percentile of the healthy population in 98%) and median serum cTnI was 13ng/L (elevated in 20%). A high cTnI (T3) was significantly associated with a higher LVMI (Beta 31.60; p=0.001) and LVEF (Beta -4.78; p=0.005) after adjusting for confounders whereas a high serum cTnT was not. CAD was significantly associated with a high cTnT (OR 4.70 p=0.02) but not with a high cTnI. Unlike cTnI, cTnT was associated with residual renal function (Beta:-0.09; p=0.006).
  
  
  CONCLUSIONS
  In the present cohort, serum cTnI levels showed a stronger association with LVMI and LVEF than cTnT. However, cTnT was significantly associated with CAD and residual renal function, unlike cTnI. Therefore, cTnI seems to be superior to cTnT as a marker of left ventricular dysfunction in asymptomatic dialysis patients, while cTnT might be better suited to detect CAD in these patients.
authors.affiliation: Department of Cardiology, Leiden University Medical Center (LUMC), Leiden, The Netherlands.
authors.forename: Maurits S
authors.initials: MS
authors.lastname: Buiten
authors.affiliation: Department of Cardiology, Leiden University Medical Center (LUMC), Leiden, The Netherlands.
authors.forename: Mihály K
authors.initials: MK
authors.lastname: de Bie
authors.affiliation: Department of Nephrology, LUMC, Leiden, The Netherlands.
authors.forename: Joris I
authors.initials: JI
authors.lastname: Rotmans
authors.affiliation: Department of Clinical Epidemiology, LUMC, Leiden, The Netherlands.
authors.forename: Friedo W
authors.initials: FW
authors.lastname: Dekker
authors.affiliation: Department of Nephrology, HAGA, The Hague, The Netherlands.
authors.forename: Marjolijn
authors.initials: M
authors.lastname: van Buren
authors.affiliation: Department of Nephrology, LUMC, Leiden, The Netherlands.
authors.forename: Ton J
authors.initials: TJ
authors.lastname: Rabelink
authors.affiliation: Department of Clinical Chemistry and Laboratory Medicine, LUMC, Leiden, The Netherlands.
authors.forename: Christa M
authors.initials: CM
authors.lastname: Cobbaert
authors.affiliation: Department of Cardiology, Leiden University Medical Center (LUMC), Leiden, The Netherlands.
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Schalij
authors.affiliation: Department of Cardiology, Leiden University Medical Center (LUMC), Leiden, The Netherlands; Department of Clinical Chemistry and Laboratory Medicine, LUMC, Leiden, The Netherlands.
authors.forename: Arnoud
authors.initials: A
authors.lastname: van der Laarse
authors.affiliation: Department of Cardiology, Leiden University Medical Center (LUMC), Leiden, The Netherlands.
authors.forename: J Wouter
authors.initials: JW
authors.lastname: Jukema
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D006435:Renal Dialysis; D019210:Troponin I / Q000097:blood*; D020107:Troponin T / Q000097:blood*; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology
chemical_list: D015415:Biomarkers; D019210:Troponin I; D020107:Troponin T