Cardiac structural and functional abnormalities in end stage renal disease patients with elevated cardiac troponin T

Sharma, Rajan; Gaze, David; Pellerin, Denis; Mehta, Rajnikant; Gregson, Helen; Streather, Christopher P.; Collinson, P; Brecker, Stephen

doi:10.1136/hrt.2005.069666

Cited by 78 publications

(71 citation statements)

References 34 publications

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“…[57,58] Assessment of diastolic function by echocardiography has shown a high incidence of abnormalities in dialysis and nondialysis CKD patients. [59,60] Similar to our study, some investigators have found abnormalities in tissue Doppler velocity in virtually all patients with CKD, suggesting a degree of subclinical myocardial disease in all such patients. [61] In the CRIC study (stage 2-4 CKD), diastolic function was abnormal in 71% of patients.…”

Section: Discussionsupporting

confidence: 89%

Pattern and severity of left ventricular diastolic dysfunction in early and end stage renal disease patients with or without dialysis in rural population in South India

Sidmal¹,

Hp²,

Kc³

2015

Int Jour of Biomed Res

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Background: The chronic kidney disease (CKD) is a major risk factor for coronary artery disease (CAD) and left ventricle systolic dysfunction. Left ventricular (LV) diastolic dysfunction in CKD patients frequently leads to the development of congestive heart failure. The interaction between diastolic dysfunction (DD) and renal function in subjects with preserved systolic function is not well defined. Objective: Our aim was to investigate whether renal insufficiency (RI) is associated with DD among patients with left ventricular ejection fraction (LVEF) > 50%, and to investigate whether there is a correlation between CKD and DD severity. Methods: Eighty four CKD patients, aged 35-79 were examined by standard echocardiography. Subjects were divided into 4 groups depending on their estimated glomerular filtration rate (eGFR: ml/min/BSA) as follows: group 1 (60-89 ml/min/BSA), group 2 (30-59 ml/min/BSA), group 3 (15-29 ml/min/BSA) and group 4 (less than 15 ml/min/BSA), between 1/2/2014 and 30/4/2015. Glomerular filtration rate (GFR) was estimated using the MDRD formula. Patients with impaired relaxation (grade I) were compared to those with pseudonormal (grade II) or restrictive (grade III-IV) DD. Results: Among 84 patients, 23 had GFR 60-89 ml/min/BSA; 16 had GFR 30-59 ml/min/BSA; and 19 had GFR 15-30 ml/min/BSA and 26 had GFR <15 ml/min/BSA. There was a significant correlation between worsening GFR and degree of diastolic dysfunction (DD) assessed by echo. Overall, 40.4% of the participants were female, 22 (26.1 %) had grade I, & 10 (11.9 %) had grade II, 16 (19%) had grade III and 36 (42.8%) had grade IV diastolic dysfunction. Almost all patients had some degree of diastolic dysfunction. With worsening of renal function, there was worsening of diastolic dysfunction seen. In patients with end stage renal disease many had grade IV diastolic dysfunction as compared to patients with early CKD. Grade I and II DD was commonly seen in group 1 and 2. But grade III and IV DD was commonly seen in group 3 and 4. Conclusion: Worsening renal function was associated with greater degree of diastolic dysfunction and adverse clinical outcomes. Our Study indicated a clear and independent association between RI and DD. The severity of RI also tends to correlate with the severity of DD. And that LV diastolic dysfunction was observed even in patients with early stages of chronic kidney dysfunction.

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Section: Discussionsupporting

confidence: 89%

Pattern and severity of left ventricular diastolic dysfunction in early and end stage renal disease patients with or without dialysis in rural population in South India

Sidmal¹,

Hp²,

Kc³

2015

Int Jour of Biomed Res

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“…In the nondialysis population, GLS is proved as a more reliable and sensitive parameter for representing LV systolic function in patients with cardiomyopathies, advanced-stage CKD, or HF with preserved LVEF (11,12,(27)(28)(29)(30). Less negative GLS is also proved as a powerful predictor of all-cause mortality in the general population (9), and is reported to be useful in the preclinical diagnosis of a number of other cardiomyopathies, including diabetes, hypertrophic cardiomyopathy, and amyloidosis (28)(29)(30). In these cardiomyopathies, only GLS precedes any clinical evidence of overt systolic dysfunction, suggesting that abnormal GLS may represent an early stage of abnormal LV geometry and function.…”

Section: Discussionmentioning

confidence: 99%

“…Although LV hypertrophy (LVH) and reduced LVEF are recognized as prognostic predictors in dialysis patients, most ESRD patients have LVH and preserved LVEF (ejection fraction $50%) (1,9,10). Therefore, a more promising method to evaluate cardiac functions is critical.…”

Section: Introductionmentioning

confidence: 99%

Association of Left Ventricular Longitudinal Strain with Mortality among Stable Hemodialysis Patients with Preserved Left Ventricular Ejection Fraction

Liu¹,

Sung

et al. 2013

Clinical Journal of the American Society of Nephrology

101

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SummaryBackground and objectives Little is known about the optimal echocardiographic parameters for risk stratification in stable dialysis patients with preserved left ventricular ejection fraction (LVEF) (ejection fraction $50%). Left ventricular (LV) global peak systolic longitudinal strain (GLS) is the ratio of the maximal change in myocardial longitudinal length in systole to the original length and reliably and accurately assesses LV function. During systole, LV myocardium in the longitudinal direction shortens and GLS is represented by a negative value. The more negative value of GLS, the better the LV function is. This study hypothesized that subtle abnormalities of GLS are associated with an adverse prognosis.Design, setting, participants, & measurements This prospective study collected clinical and echocardiographic data (including GLS) from 88 stable hemodialysis patients (mean age 67.0611.2 years; 35% men) with preserved LVEF. These patients were enrolled from December 2008 to January 2009 and were followed-up for 25.669.9 months. The primary outcome was all-cause mortality. Multivariate Cox regression analysis was used to investigate risk factors for mortality.Results The mortality group (n=24) had lower albumin levels, less negative GLS, and higher prevalence of coronary artery disease and diabetes mellitus than the survival group. Using a GLS cutoff value of 215%, the less negative GLS group (GLS $215%) had a higher mortality rate. Cox regression analyses revealed that lower albumin level (hazard ratio, 0.16; 95% confidence interval, 0.05 to 0.53; P=0.003) and less negative GLS (hazard ratio, 3.57; 95% confidence interval, 1.41 to 9.04; P=0.01) were independent predictors of all-cause mortality. Furthermore, less negative GLS was associated with a higher cardiovascular death rate.Conclusions Less negative GLS is predictive of poor prognosis among stable hemodialysis patients with preserved LVEF.

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“…This causes progressive difficulty in troponin interpretation for a growing number of 'positive' individuals and increases the risk of misinterpretation (Table 1). [24][25][26] It may be argued this is irrelevant, as any troponin rise no matter what the underlying cause is significant and therefore worthwhile detecting. While this is true, the value of such a diagnosis and allocation of resources in doing so may be limited if the risk cannot be modified as a result e.g.…”

Section: Troponinmentioning

confidence: 99%

“…25 Troponin elevation in chronic renal failure patients is associated with evidence of diffuse myocardial injury. 26,27 The current generation of troponin assays is able to measure troponin levels in healthy normal individuals. It has been shown that the presence of an elevated troponin above the reference interval, currently defined as the 99th percentile, is associated with other cardiac risk factors 28 and with an increased risk of cardiac events such as MI 29,30 or risk of development of heart failure.…”

Section: Po Collinsonmentioning

confidence: 99%

Triage of acute onset chest pain: now a biochemical rule-out test?

Bloomfield²,

Po³

2012

J R Coll Physicians Edinb

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Cardiac structural and functional abnormalities in end stage renal disease patients with elevated cardiac troponin T

Abstract: Patients with ESRD with raised cTnT concentrations have increased mortality. Raised concentrations are strongly associated with diabetes, LV dilatation, and impaired LV systolic and diastolic function, but not with severe coronary artery disease.

Cited by 78 publications

References 34 publications

Pattern and severity of left ventricular diastolic dysfunction in early and end stage renal disease patients with or without dialysis in rural population in South India

Pattern and severity of left ventricular diastolic dysfunction in early and end stage renal disease patients with or without dialysis in rural population in South India

Association of Left Ventricular Longitudinal Strain with Mortality among Stable Hemodialysis Patients with Preserved Left Ventricular Ejection Fraction

Triage of acute onset chest pain: now a biochemical rule-out test?

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