High-Sensitivity Cardiac Troponin Concentrations in Patients with Chest Discomfort: Is It the Heart or the Kidneys As Well?
BACKGROUND
High-sensitivity cardiac troponins (hs-cTn) are the preferred biomarkers to detect myocardial injury, making them promising risk-stratifying tools for patients with symptoms of chest pain. However, circulating hs-cTn are also elevated in other conditions like renal dysfunction, complicating appropriate interpretation of low-level hs-cTn concentrations.


METHODS
A cross-sectional analysis was performed in 1864 patients with symptoms of chest discomfort from the cardiology outpatient department who underwent cardiac computed tomographic angiography (CCTA). Serum samples were analyzed using hs-cTnT and hs-cTnI assays. Renal function was measured by the estimated glomerular filtration rate (eGFR), established from serum creatinine and cystatin C. On follow-up, the incidence of adverse events was assessed.


RESULTS
Median hs-cTnT and hs-cTnI concentrations were 7.2(5.8-9.2) ng/L and 2.6(1.8-4.1) ng/L, respectively. Multivariable regression analysis revealed that both assay results were more strongly associated with eGFR (hs-cTnT:stβ:-0.290;hs-cTnI:stβ:-0.222) than with cardiac imaging parameters, such as coronary calcium score, CCTA plaque severity score and left ventricular mass (all p<0.01). Furthermore, survival analysis indicated lower relative risks in patients with normal compared to reduced renal function for hs-cTnT [HR(95%CI), 1.02(1.00-1.03) compared to 1.07(1.05-1.09)] and hs-cTnI [1.01(1.00-1.01) compared to 1.02(1.01-1.02)] (all p<0.001).


CONCLUSIONS
In patients with chest discomfort, we identified an independent influence of renal function on hs-cTn concentrations besides CAD, that affected the association of hs-cTn concentrations with adverse events. Estimating renal function is therefore warranted when interpreting baseline hs-cTn concentrations.
Central Diagnostic Laboratory, Department of Clinical Chemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands.
Eline P M
EP
Cardinaels
Department of Cardiology, CARIM, MUMC+, Maastricht, the Netherlands.
Sibel
S
Altintas
Department of Cardiology, CARIM, MUMC+, Maastricht, the Netherlands.
Mathijs O
MO
Versteylen
Department of Cardiology, CARIM, MUMC+, Maastricht, the Netherlands.
Ivo A
IA
Joosen
Department of Clinical Chemistry and Hematology, Gelre Hospitals, Apeldoorn, the Netherlands.
Laurens-Jan C
LJ
Jellema
Department of Radiology, CARIM, MUMC+, Maastricht, the Netherlands.
Joachim E
JE
Wildberger
Department of Radiology, CARIM, MUMC+, Maastricht, the Netherlands.
Marco
M
Das
Department of Cardiology, CARIM, MUMC+, Maastricht, the Netherlands.
Harry J
HJ
Crijns
Central Diagnostic Laboratory, Department of Clinical Chemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands.
Otto
O
Bekers
Central Diagnostic Laboratory, Department of Clinical Chemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands.
Marja P
MP
van Dieijen-Visser
Department of Cardiology, CARIM, MUMC+, Maastricht, the Netherlands.|Department of Radiology, CARIM, MUMC+, Maastricht, the Netherlands.
Bastiaan L
BL
Kietselaer
Central Diagnostic Laboratory, Department of Clinical Chemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands.
Alma M A
AM
Mingels
D015415:Biomarkers / Q000097:blood; D002637:Chest Pain / Q000097:blood*; D003324:Coronary Artery Disease / Q000097:blood / Q000503:physiopathology; D003404:Creatinine / Q000097:blood; D003430:Cross-Sectional Studies; D055316:Cystatin C / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006321:Heart / Q000502:physiology*; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D007677:Kidney Function Tests / Q000379:methods; D008297:Male; D008875:Middle Aged; D014336:Troponin / Q000097:blood*; D019210:Troponin I / Q000097:blood; D020107:Troponin T / Q000097:blood
D015415:Biomarkers; D055316:Cystatin C; D014336:Troponin; D019210:Troponin I; D020107:Troponin T; D003404:Creatinine