Contribution of Renal Function Impairment to Unexplained Troponin T Elevations in Congestive Heart Failure

Abstract

Background. Patients with severe congestive heart failure (CHF) often have unexplained elevations in serum concentrations of troponin T (TnT), and it is proposed that this is due to cardiac TnT release because of underlying cardiac disease. We investigated whether impaired renal function is an additional underlying phenomenon contributing to increased TnT levels in patients with CHF. Methods. Sixty-two patients with nonischemic CHF, New York Heart Association (NYHA) class III-IV, with normal coronary angiogram and normal serum creatinine were included in the study. Baseline glomerular filtration rate (GFR) was calculated using the Cockcroft Gault equation. Results. Although mean creatinine level was normal (0.92 ± 0.17 mg/dL), mean GFR was low (56 ± 16 mL/min) in the cohort. Elevated (≥0.02 μg/L) TnT was measured in 33 patients (53%). Compared with patients with normal (<0.02 μg/L) TnT levels, patients with elevated TnT had significantly higher NYHA class (p = 0.02), longer duration of disease (p = 0.02), lower GFR (p = 0.0001), and lower LVEF (p = 0.0001). There were significant associations between TnT levels and duration of disease (r = 0.29, p = 0.01), creatinine (r = 0.30, p = 0.01), GFR (r = −0.55, p < 0.0001), and LVEF (r = −0.39, p = 0.001). Independence of these associations was evaluated in multiple linear regression analysis, and serum TnT was independently and negatively associated only with GFR (p = 0.005). Conclusions. Renal function (GFR) correlated significantly and more strongly than cardiac function (LVEF) with the serum TnT levels in patients with CHF. This supports our hypothesis that impaired renal function causes the accumulation of troponin and is very likely the cause of unexplained elevations of serum TnT in patients severe CHF.

Diagnostic accuracy of point-of-care testing for acute coronary syndromes, heart failure and thromboembolic events in primary care: a cluster-randomised controlled trial

“…Non-inclusion criteria were refusal of consent, presentation >5 days after symptom onset, recent anticoagulant treatment, severe renal dysfunction and cancer therapy. Rationales for the exclusion criteria were the normalisation of the cTnT level five days after ACS, the fact that cTnT may be increased even in the absence of clinically suspected acute myocardial ischemia in patients with renal insufficiency, and the unpredictable effect of anticoagulant treatment and cancer therapy on the biomarkers' concentration [12,13]. …”

Sex, Myocardial Infarction, and the Failure of Risk Scores in Women

“…17 Furthermore, new studies should be carried out to determine whether previously observed non-CVD specific elevation of circulating cTnT in patients with chronic kidney disease or reduced GFR is maintained with the application of new high sensitivity assays in comparison to cTnI, which previously demonstrated better correlation to true myocardial injury in the same patient cohorts. [18][19][20] In terms of sex differences in cardiac arrest, several studies have shown that women who suffer a cardiac arrest have higher survival to hospital admission but worse prognosis in the hospital. [21][22][23] It is speculated that the reason women may have increased survival to the hospital is that women are more likely to activate vagal compensatory mechanisms in response to abrupt coronary occlusion, which have beneficial antiarrythmic effects.…”

Troponins in Acute Kidney Injury

“…And the authors postulated that it is the impaired renal function that causes the accumulation of troponin. 16,17 Factors associated with elevated TAKI such as previous heart disease and advanced age suggest that these patients were more likely to have underlying heart disease and therefore possibly higher basal serum troponin concentrations. A study investigating the plasma elimination of cardiac troponin I after acute myocardial infarction in ESRD showed increased half-life in those patients with ESRD compared with normal patients.…”