Associations of sensitive cardiac troponin-I with left ventricular morphology, function and prognosis in end-stage renal disease patients with preserved ejection fraction

Otsuka, Kenichiro; Nakanishi, Koki; Shimada, Kenei; Nakamura, Haruo; Inanami, Hitoshi; Nishioka, Hiroki; Fujimoto, Kohei; Kasayuki, Noriaki; Yoshiyama, Minoru

doi:10.1007/s00380-018-1192-7

Cited by 13 publications

(14 citation statements)

References 37 publications

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“…TTDE examination was also performed after the HD session at the study enrollment using a commercially available system (the Vivid 7; General Electric, Milwaukee, Wisconsin) by trained cardiac echo sonographers. Left ventricular ejection fraction (LVEF) was calculated by using Simpson method from apical 4‐ and 2‐chamber views, as previously reported . In the present study, LVEF <50% was defined as decreased LVEF.…”

Section: Methodsmentioning

confidence: 84%

“…Left ventricular ejection fraction (LVEF) was calculated by using Simpson method from apical 4-and 2-chamber views, as previously reported. 21 In the present study, LVEF <50% was defined as decreased LVEF.…”

Section: (B) Patients With Systemic Infection or Chronic Inflammatorymentioning

confidence: 80%

“…With the widespread clinical application of standardized assays, several biomarkers and multiple biomarker approach enable the accurate prediction of the long‐term prognosis of ESKD patients treated with HD . Previous studies have demonstrated that cardiac troponin (cTn), brain‐natriuretic peptide (BNP), and C‐reactive protein (CRP) are the robust predictors of MACE independent of traditional risk factors and two‐dimensional thoracic Doppler echocardiography (TTDE) findings . However, the prognostic significance of ABI/PWV in association with biomarkers have not been fully investigated in ESKD patients.…”

Section: Introductionmentioning

confidence: 99%

“…[15][16][17] Previous studies have demonstrated that cardiac troponin (cTn), brain-natriuretic peptide (BNP), and C-reactive protein (CRP) are the robust predictors of MACE independent of traditional risk factors and two-dimensional thoracic Doppler echocardiography (TTDE) findings. [18][19][20][21] However, the prognostic significance of ABI/PWV in association with biomarkers have not been fully investigated in ESKD patients. In addition, the heterogeneous risks of ESKD patients might require risk assessment approach from multiple aspects.…”

Section: Introductionmentioning

confidence: 99%

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Ankle‐brachial index, arterial stiffness, and biomarkers in the prediction of mortality and outcomes in patients with end‐stage kidney disease

Otsuka

Nakanishi

Shimada

et al. 2019

Clinical Cardiology

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Background Although ankle‐brachial index (ABI) and brachial‐ankle pulse wave velocity (baPWV) are significant predictors of major adverse cardiovascular event (MACE), their prognostic value in association with biomarkers has not been fully evaluated in patients with end‐stage kidney disease (ESKD). Hypothesis We hypothesized that ABI/baPWV would provide better prognostic value independent of biomarkers in ESKD patients. Methods This study included 104 ESKD patients treated with maintenance hemodialysis who underwent ABI and baPWV examinations and laboratory tests, including brain‐natriuretic peptide, high‐sensitive cardiac troponin T (hs‐cTnT), and high‐sensitive C‐reactive protein (hs‐CRP). MACE was defined as a composite event of all‐cause death, acute coronary syndrome, and stroke. Results During a mean follow‐up of 3.6 ± 1.7 years, a total of 51 MACE were observed. The independent factors associated with MACE were age >75 years (adjusted hazard ratio [HR], 2.15; P < .05), abnormal ABI (adjusted HR, 2.01; P < .05), left ventricular ejection fraction (LVEF) <50% (adjusted HR, 3.33; P < .001), the upper tertile of hs‐cTnT (adjusted HR, 2.77; P < .05), and hs‐CRP (HR, 1.96; P < .05). However, baPWV did not remain as an independent predictor of MACE in the entire cohort and also in patients without abnormal ABI. The combination of predictors improves the predictive value of MACE, providing increased HR with 4.00 for abnormal ABI + hs‐CRP, 4.42 for abnormal ABI + hs‐cTnT, and 7.04 for abnormal ABI + LVEF <50% (all P < .001). Conclusion Abnormal ABI is a robust predictor of MACE independent of biomarkers and their combination provides better risk stratification compared with a single predictor in ESKD patients.

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Section: Methodsmentioning

confidence: 84%

Section: (B) Patients With Systemic Infection or Chronic Inflammatorymentioning

confidence: 80%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Ankle‐brachial index, arterial stiffness, and biomarkers in the prediction of mortality and outcomes in patients with end‐stage kidney disease

Otsuka

Nakanishi

Shimada

et al. 2019

Clinical Cardiology

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“…Two studies [ 10 , 11 ] examined the prognostic value of CRP as a categorical variable in predicting CV mortality in HFpEF patients (Fig. 3a ).…”

Section: Resultsmentioning

confidence: 99%

Diagnostic and prognostic value of serum C-reactive protein in heart failure with preserved ejection fraction: a systematic review and meta-analysis

et al. 2020

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Heart failure (HF) is a major epidemic with rising morbidity and mortality rates that encumber global healthcare systems. While some studies have demonstrated the value of CRP in predicting (i) the development of HFpEF and (ii) long-term clinical outcomes in HFpEF patients, others have shown no such correlation. As a result, we conducted the following systematic review and meta-analysis to assess both the diagnostic and prognostic role of CRP in HFpEF. PubMed and Embase were searched for studies that assess the relationship between CRP and HFpEF using the following search terms: (((C-reactive protein) AND ((preserved ejection fraction) OR (diastolic heart failure))). The search period was from the start of database to August 6, 2019, with no language restrictions. A total of 312 and 233 studies were obtained from PubMed and Embase respectively, from which 19 studies were included. Our meta-analysis demonstrated the value of a high CRP in predicting the development of not only new onset HFpEF (HR: 1.08; 95% CI: 1.00-1.16; P = 0.04; I 2 = 22%), but also an increased risk of cardiovascular mortality when used as a categorical (HR: 2.52; 95% CI: 1.61-3.96; P < 0.0001; I 2 = 19%) or a continuous variable (HR: 1.24; 95% CI: 1.04-1.47; P = 0.01; I 2 = 28%), as well as all-cause mortality when used as a categorical (HR: 1.78; 95% CI: 1.53-2.06; P < 0.00001; I 2 = 0%) or a continuous variable: (HR: 1.06; 95% CI: 1.02-1.06; P = 0.003; I 2 = 61%) in HFpEF patients. CRP can be used as a biomarker to predict the development of HFpEF and long-term clinical outcomes in HFpEF patients, in turn justifying its use as a simple, accessible parameter to guide clinical management in this patient population. However, more prospective studies are still required to not only explore the utility and dynamicity of CRP in HFpEF but also to determine whether risk stratification algorithms incorporating CRP actually provide a material benefit in improving patient prognosis.

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Routinely measured cardiac troponin I and N‐terminal pro‐B‐type natriuretic peptide as predictors of mortality in haemodialysis patients

et al. 2022

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Aims Cardiac troponin (cTn) and B-type natriuretic peptide (BNP) are elevated in haemodialysis (HD) patients, and this elevation is associated with HD-induced myocardial stunning/myocardial strain. However, studies using data from the international Dialysis Outcomes and Practice Patterns Study (DOPPS) have shown that these cardiac biomarkers are measured in <2% of HD patients in real-world practice. This study aimed to examine whether routinely measured N-terminal pro-BNP (NT-proBNP) and cTnI (contemporary assay) are more appropriate than clinical models for reclassifying the risk of HD patients who have the highest risk of death. Methods and resultsPre-dialysis levels of cTnI and NT-proBNP at study enrolment were measured in 1152 HD patients (Japan DOPPS Phase 5). The patients were prospectively followed for 3 years. Cox regression was used to test the associations of cardiac biomarkers with all-cause mortality, adjusting for potential confounders. Subgroup analyses were performed to assess potential effect modification of clinical characteristics, such as age, systolic blood pressure, HD vintage, diabetes mellitus, coronary artery disease, and a history of congestive heart failure. At baseline, 337 (29%) patients had elevated cTnI (99th percentile of a healthy population: >0.04 ng/mL) with a median (inter-quartile range) level of 0.020 (0.005-0.041) ng/mL, and 1140 (99%) patients had elevated NT-proBNP (cut-off for heart failure: >125 pg/mL) with a median level of 3658 (1689-9356) pg/mL. There were 167 deaths during a median follow-up of 2.8 (2.2-2.8) years. Higher levels of both cardiac biomarkers were incrementally associated with mortality after adjustment for potential confounders. Even after adjustment for alternative cardiac biomarkers, the overall P value for the association was <0.01 for both biomarkers. However, the prognostic significance of NT-proBNP was moderately diminished when cTnI was added to the model. The hazard ratios of mortality for cTnI > 0.04 ng/mL (vs. cTnI < 0.006 ng/mL) and NT-proBNP > 8000 pg/mL (vs. NT-proBNP < 2000 pg/mL) were 2.56 (95% confidence interval: 1.37-4.81) and 1.90 (95% confidence interval: 0.95-3.79), respectively. Subgroup analyses showed that the associations of both cardiac biomarkers with mortality were generally consistent between stratified groups. Conclusions Routinely measured NT-proBNP and cTnI levels are strongly associated with mortality among prevalent HD patients. These associations remain robust, even after adjustment for alternative biomarkers, suggesting that cTnI and NT-proBNP have identical prognostic significance and may reflect different pathological aspects of cardiac abnormalities.

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Associations of sensitive cardiac troponin-I with left ventricular morphology, function and prognosis in end-stage renal disease patients with preserved ejection fraction

Cited by 13 publications

References 37 publications

Ankle‐brachial index, arterial stiffness, and biomarkers in the prediction of mortality and outcomes in patients with end‐stage kidney disease

Ankle‐brachial index, arterial stiffness, and biomarkers in the prediction of mortality and outcomes in patients with end‐stage kidney disease

Diagnostic and prognostic value of serum C-reactive protein in heart failure with preserved ejection fraction: a systematic review and meta-analysis

Routinely measured cardiac troponin I and N‐terminal pro‐B‐type natriuretic peptide as predictors of mortality in haemodialysis patients

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