Association of Cardiac Troponin T With Left Ventricular Structure and Function in CKD

Abstract

Background Serum cardiac troponin T (cTnT) is associated with increased risk of heart failure and cardiovascular death in several population settings. We evaluated associations of cTnT with cardiac structural and functional abnormalities in a cohort of chronic kidney disease (CKD) patients without heart failure. Study Design Cross-sectional. Setting & Participants Chronic Renal Insufficiency Cohort (CRIC; N= 3,243) Predictor The primary predictor was cTnT. Secondary predictors included demographic and clinical characteristics, hemoglobin level, high-sensitivity C-reactive protein, and estimated glomerular filtration rate using cystatin C. Outcomes Echocardiography was used to determine left ventricular (LV) mass and LV systolic and diastolic function. Measurements Circulating cTnT was measured in stored sera using the highly sensitive assay. Logistic and linear regression models were used to examine associations of cTnT with each echocardiographic outcome. Results cTnT was detectable in 2,735 (84%) persons; the median was 13.3 (IQR, 7.7–23.8) pg/mL. Compared with undetectable cTnT (<3.0 pg/mL), the highest quartile (23.9 – 738.7 pg/mL) was associated with approximately two times as likely to experience LV hypertrophy (OR, 2.43; 95% CI, 1.44–4.09) in the fully adjusted model. cTnT had a more modest association with LV systolic dysfunction; as a log-linear variable, a significant association was present in the fully adjusted model (OR of 1.4 [95% CI, 1.1–1.7] per 1-log unit; p<0.01). There was no significant independent association between cTnT and LV diastolic dysfunction. When evaluated as a screening test, cTnT functioned only modestly for LV hypertrophy and concentric hypertrophy detection (area under the curve, 0.64 for both) with weaker areas under the curve for the other outcomes. Limitations The presence of coronary artery disease was not formally assessed using either noninvasive or angiographic techniques in this study. Conclusions In this large CKD cohort without heart failure, detectable cTnT had a strong association with LV hypertrophy, a more modest association with LV systolic dysfunction, and no association with diastolic dysfunction. These findings indicate that circulating cTnT levels in CKD are predominantly an indicator of pathological LV hypertrophy.

High-Sensitivity Troponin T and N-Terminal Pro-B-Type Natriuretic Peptide (NT-proBNP) and Risk of Incident Heart Failure in Patients with CKD

“…Our findings are consistent with a previous analysis of 8000 participants with albuminuria in the Prevention of Renal and Vascular End-Stage Disease (PREVEND) Study, which showed that hsTnT was associated with incident cardiovascular events, even after adjustment for eGFR and severity of albuminuria. 17 Prior studies have also shown that elevated hsTnT is associated with abnormal left ventricular structure and function in patients with 12,18 and without CKD. 11 Among participants in the CRIC Study, those with the highest quartile of detectable hsTnT had a 2-fold higher odds of LVH compared with those in the lowest quartile.…”

NT-ProBNP and Troponin T and Risk of Rapid Kidney Function Decline and Incident CKD in Elderly Adults

“…Our results expand on these prior studies by reporting a strong association between elevated NT-proBNP and clinically relevant changes in kidney function before the onset of clinically diagnosed CKD among a large, multicenter, community-based cohort of elderly adults free of HF at baseline across a range of kidney function. Concentrations of TnT may become elevated in response to myocardial injury, myocardial remodeling, or LVH (14,15). Very few studies have examined associations of elevations in TnT and decline in kidney function.…”

“…NT-proBNP is secreted into the circulation from cardiac myocytes in response to stimuli, such as pressure or volume overload (13). Similarly, TnT concentrations may become elevated in response to myocardial injury, myocardial remodeling, or left ventricular hypertrophy (LVH) (14,15). Elevated NT-proBNP and TnT concentrations may serve as early markers of abnormal cardiac physiology, which may also be associated with poor kidney outcomes as well.…”

“…Levels of NT-proBNP and TnT are commonly elevated in patients with reduced kidney function (15)(16)(17)(18)(19)(20)(21), resulting from multiple physiologic stresses, including extracellular volume expansion, LVH, myocardial ischemia, and possibly, reduced renal clearance (16,20,(22)(23)(24). Most studies to date have primarily focused on the association between NT-proBNP and TnT and cardiovascular and/or all-cause death.…”

Masked Hypertension and Elevated Nighttime Blood Pressure in CKD

“…The protocol for obtaining echocardiograms has been described previously (23,24). LVMI was calculated on the basis of the area-length formula and indexed to height 2.7 (25).…”