A More Appropriate Cardiac Troponin T Level That Can Predict Outcomes in End-Stage Renal Disease Patients with Acute Coronary Syndrome

Abstract

PurposeCardiac troponin T (cTnT), a useful marker for diagnosing acute myocardial infarction (AMI) in the general population, is significantly higher than the usual cut-off value in many end-stage renal disease (ESRD) patients without clinically apparent evidence of AMI. The aim of this study was to evaluate the clinical usefulness of cTnT in ESRD patients with acute coronary syndrome (ACS).Materials and MethodsTwo hundred eighty-four ESRD patients with ACS were enrolled between March 2002 and February 2008. These patients were followed until death or June 2009. Medical records were reviewed retrospectively. The cut-off value of cTnT for AMI was evaluated using a receiver operating characteristic (ROC) curve. We calculated Kaplan-Meier survival curves, and potential outcome predictors were determined by Cox proportional hazard analysis.ResultsAMIs were diagnosed in 40 patients (14.1%). The area under the curve was 0.98 in the ROC curve (p<0.001; 95% CI, 0.95-1.00). The summation of sensitivity and specificity was highest at the initial cTnT value of 0.35 ng/mL (sensitivity, 0.95; specificity, 0.97). Survival analysis showed a statistically significant difference in all-cause and cardiovascular mortalities for the group with an initial cTnT ≥0.35 ng/mL compared to the other groups. Initial serum cTnT concentration was an independent predictor for mortality.ConclusionBecause ESRD patients with an initial cTnT concentration ≥0.35 ng/mL have a poor prognosis, it is suggested that urgent diagnosis and treatment be indicated in dialysis patients with ACS when the initial cTnT levels are ≥0.35 ng/mL.

High sensitive TROponin levels In Patients with Chest pain and kidney disease: A multicenter registry — The TROPIC study

“…The role of this elevation is well documented for non high sensitive troponin, which was predictive for short and long-term risk of death or myocardial infarction in ACS patients across all degrees of kidney disease [29][30][31]. Moreover no differences among various assays were recently demonstrated in subgroup analysis of CRUSADE [32], especially for patients reporting higher levels of troponin (for TnT 9% vs. 14%; for TnI 6% vs. 14%).…”

Utility of Traditional Circulating and Imaging-Based Cardiac Biomarkers in Patients with Predialysis CKD

“…A cTnT cutoff of 350 ng/L (.10-fold higher than the recommended cutoff for general use) had the best sensitivity (95%) and specificity (97%) for AMI in 284 patients with ESRD presenting with chest pain (7). In 89 patients with asymptomatic CKD stages 3-5, the 95th percentile for hscTnT was 139 ng/L, .10-fold higher than that derived in the general population (8), with levels increasing across higher CKD stages.…”

Improving the hydrophilic properties of wool fabrics via corona discharge and hydrogen peroxide treatment

“…Corona discharge has been widely used to modify the surface of wool fibers because of its etching effects on the top of scales. It has been applied to improve the shrink and dyeing properties of wool fabrics [3][4][5][6] and to pretreat wool fiber for grafting. 7,8 Corona discharge is achieved by the application of a high-frequency voltage between an electrode and an earthed dielectric roll.…”

“…7,8 Corona discharge is achieved by the application of a high-frequency voltage between an electrode and an earthed dielectric roll. 6 It is simple and versatile, and no vacuum is needed; thus, it can be commercialized easily. The wettability of wool fiber after corona discharge has been observed, but no further investigation has been performed.…”

“…The wettability of wool fiber after corona discharge has been observed, but no further investigation has been performed. 6,9 Previously, we combined corona discharge with an enzyme and resin treatment to change the shrink properties of wool fabrics. 9 On the other hand, hydrogen peroxide is widely used for the bleaching of wool fabrics.…”