Biological variation of high sensitivity cardiac troponin-T in stable dialysis patients: implications for clinical practice

Fahim, Magid; Hayen, Andrew; Horvath, Andrea R.; Dimeski, Goce; Coburn, Amanda; Tan, Ken‐Soon; Johnson, David W.; Craig, Jonathan C.; Campbell, Scott; Hawley, Carmel M.

doi:10.1515/cclm-2014-0838

Cited by 25 publications

(26 citation statements)

References 20 publications

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“…Compared with older troponin T assays that were reported to be elevated in up to 82% of the dialysis population, we found an even higher proportion with elevated hs‐cTnT (97%), which is consistent with other studies performed on hs‐cTnT . Previous studies on hs‐cTnT analyzed it as a continuous variable .…”

Section: Discussionsupporting

confidence: 90%

High‐Sensitivity Troponin T and C‐Reactive Protein Have Different Prognostic Values in Hemo‐ and Peritoneal Dialysis Populations: A Cohort Study

Chen

Hassan

Qian

et al. 2018

JAHA

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BackgroundDialysis patients have an exceedingly high mortality rate. Biomarkers may be useful tools in risk stratification of this population. We evaluated the prognostic value of high‐sensitivity cardiac troponin T (hs‐cTnT) and CRP (C‐reactive protein) in predicting adverse outcomes in stable hemodialysis and peritoneal dialysis (PD) patients. Variability in hs‐cTnT was also examined.Methods and ResultsA retrospective cohort study included 574 dialysis patients (hemodialysis 347, PD 227). Outcomes examined included mortality and major adverse cardiovascular events, with median follow‐up of 3.5 years. hs‐cTnT was an independent predictor of both outcomes in hemodialysis and PD patients. Increased risk only became significant when hs‐cTnT reached quintile 3 (>49 ng/L). Area under the receiver operating curve analysis showed that the addition of hs‐cTnT to clinical parameters significantly improved its prognostic performance for mortality in PD patients (P=0.002). CRP was an independent predictor of both outcomes in PD patients only. Only CRP in the highest quintile (>16.8 mg/L) was associated with increased risk. hs‐cTnT remained relatively stable for the whole follow‐up period for hemodialysis patients, whereas for PD patients, hs‐cTnT increased by 23.63% in year 2 and 29.13% in year 3 compared with baseline (P<0.001).Conclusionshs‐cTnT and CRP are useful tools in predicting mortality and major adverse cardiovascular events in hemodialysis and PD patients. Given that hs‐cTnT levels increase over time in PD patients, interval monitoring may be valuable for risk assessment. In contrast, hs‐cTnT in hemodialysis patients has little interval change and progress monitoring is not indicated.

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Section: Discussionsupporting

confidence: 90%

High‐Sensitivity Troponin T and C‐Reactive Protein Have Different Prognostic Values in Hemo‐ and Peritoneal Dialysis Populations: A Cohort Study

Chen

Hassan

Qian

et al. 2018

JAHA

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“…Current understanding of cTn variability is insufficient in these cohorts, as relatively few studies have been performed in individuals with renal or cardiac disease, as summarised in Table 2 and Table 3 respectively. 36,37,[71][72][73]75,[81][82][83][84][85] Interestingly, the biological variability of cTn has been found to be fairly similar between healthy individuals and individuals requiring dialysis. 36,71,73 Furthermore, the biological variability of cTn in individuals with stable coronary artery disease or cardiac failure has also been found to be comparable to that in healthy individuals.…”

Section: Biological Variation Results From Previous Studiesmentioning

confidence: 99%

Revisiting the Biological Variability of Cardiac Troponin: Implications for Clinical Practice

Lan

Bell

2019

CBR

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The diagnosis of acute myocardial injury requires a rise and/or fall of cardiac troponin (cTn) on serial testing, with at least one concentration above the 99th percentile value of a normal reference population according to the recently published Fourth Universal Definition of Myocardial Infarction.1 However, the magnitude of change in cTn that constitutes a significant rise and/or fall was again not specified in detail. High-sensitivity cardiac troponin (hs-cTn) assays can measure ten-fold lower concentrations of cTn with more precision than older assays, and can accurately quantitate cTn in more than 50% of healthy individuals with a coefficient of variation of less than 10% at the 99th percentile. These hs-cTn assays are also able to detect the normal variations in cTn results that are due to biological variability. Understanding and quantifying the normal variations in cTn is important as this would allow significant changes to be better defined. Numerous studies have sought to investigate the biological variability of cTn over the last ten years. Such studies are usually conducted in healthy individuals, however individuals with chronic cardiac disease or chronic renal failure have also been examined. These studies have yielded varying results in regards to significant change values for cTn. In light of the recent redefinition for myocardial infarction, the purpose of this mini-review is to revisit the biological variability of cTn. In particular, we outline concepts for determining a significant change value, review the results of previous studies on the biological variation of cTn and discuss potential considerations for clinical practice.

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“…In the present population cTn levels were shown to be high but stable compared to reference values. However, conflicting findings are present on the acute effect of HD on cTn levels [8,13,24,30]. Nevertheless, clinicians must mainly rely on cTn measurements since patients with chronic kidney disease also have the most cardiovascular risk factors and ischemic findings on electrocardiography which could be present due to LV hypertrophy.…”

Section: Clinical Perspective Of Hs-ctnt Increase After Hdmentioning

confidence: 99%

High-sensitive troponin T increase after hemodialysis is associated with left ventricular global longitudinal strain and ultrafiltration rate

et al. 2020

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Background: Circulating troponin levels are both stable and higher in patients with end-stage renal disease, even in the absence of acute coronary syndrome. These patients commonly have underlying cardiac problems that frequently cause troponin elevation. The effect of hemodialysis (HD) on troponin levels has not been well elucidated. Thus, investigated herein is the relationship between the changes in troponin levels along with left ventricular deformation and volume depletion in patients with end-stage renal disease. Methods: Patients included were between 18 and 85 years of age and were receiving hemodialysis for at least 6 months. High sensitive cardiac troponin T (hs-cTnT) levels were studied in blood samples taken at the beginning and end of HD. Two-dimensional speckle tracking strain imaging was used to evaluate myocardial contractility. Results: Seventy patients (50.7 ± 16.9 years of age, 27 women) were included in study. The mean volume of ultrafiltration was 3260 ± 990 mL. A significant increase in circulating hs-cTnT levels was observed, as well as a prominent decrease in left ventricular global longitudinal strain (GLS) after

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Biological variation of high sensitivity cardiac troponin-T in stable dialysis patients: implications for clinical practice

Abstract: Background: Changes in high sensitivity cardiac troponin-T (hs-cTnT) concentrations may reflect either acute myocardial injury or biological variation. Distinguishing between these entities is essential to accurate diagnosis, however, the biological variation of hs-cTnT in dialysis

Cited by 25 publications

References 20 publications

High‐Sensitivity Troponin T and C‐Reactive Protein Have Different Prognostic Values in Hemo‐ and Peritoneal Dialysis Populations: A Cohort Study

High‐Sensitivity Troponin T and C‐Reactive Protein Have Different Prognostic Values in Hemo‐ and Peritoneal Dialysis Populations: A Cohort Study

Revisiting the Biological Variability of Cardiac Troponin: Implications for Clinical Practice

High-sensitive troponin T increase after hemodialysis is associated with left ventricular global longitudinal strain and ultrafiltration rate

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