False-Positive Cardiac Troponin T Levels in Chronic Hemodialysis Patients

Escalon, Juan C.; Wong, Shan S.

doi:10.1159/000177101

Cited by 16 publications

(8 citation statements)

References 4 publications

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“…Although the baseline CPK levels were elevated due to the active dermatomyositis, our patient developed increased serum levels of troponin T. Noncoronary causes such as severe hypertension, massive pulmonary thromboembolism, dermatomyositis, polymyositis, renal insufficiency, MOF, and sepsis have all been documented to produce mild to moderate elevations of these highly cardiac-specific enzymes (15)(16)(17)(18)(19), although none of the previous reports have documented extremely elevated levels, as in our case. We postulate a combination of direct toxic effects of pancreatic amylase and lipase on the myocardium in addition to MOF to account for the elevated troponin levels, as there was no angiographic or echocardiographic evidence of significant obstructive coronary disease.…”

Section: Discussioncontrasting

confidence: 52%

ST Segment Elevation Pattern of Acute Myocardial Infarction Induced by Acute Pancreatitis

Albrecht¹,

Laws²

2003

Cardiology in Review

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The authors report the first emergent angiographic assessment of the coronaries with accompanying echocardiography in a 64-year-old man with dermatomyositis, who presented with ST segment elevation and cardiac specific enzyme derangements highly suggestive of myocardial infarction in the presence of acute pancreatitis. Both studies revealed no anatomical or functional evidence of obstructive coronary disease. Although the mechanism of electrocardiogram abnormalities found in acute pancreatitis remains to be elucidated fully, the authors propose a direct cardiac toxic effect by the pancreatic proteolytic enzymes to account for these changes and we recommend an angiographic approach as the first step to avoid the potentially lethal administration of thrombolytic therapy or potent anticoagulation.

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Section: Discussioncontrasting

confidence: 52%

ST Segment Elevation Pattern of Acute Myocardial Infarction Induced by Acute Pancreatitis

Albrecht¹,

Laws²

2003

Cardiology in Review

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“…Most studies have not shown a relationship between serum creatinine and frequency or the degree of troponin elevation. 43,[72][73][74] The half-life and clearance of TnI after an acute myocardial infarction appears similar between patients with normal renal function and ESRD. 75 Death of cardiac cells occurs in heart failure.…”

Section: Aetiology Of An Elevated Cardiac Troponin In Renal Failurementioning

confidence: 97%

Cardiac troponins and renal disease

Zoysa¹

2004

Nephrology

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SUMMARY: Cardiovascular disease is the most common cause of death in patients with renal failure. Patients with renal failure are at greater risk of atypical presentations of myocardial ischaemia. Traditional markers of myocardial damage are often increased in renal failure in the absence of clinically suspect myocardial ischaemia. The cardiac troponins are specific markers of myocardial injury. Large-scale trials, excluding patients with renal disease, have shown the importance of the cardiac troponins in predicting adverse outcome and in guiding both therapy and intervention in acute coronary syndromes. Cardiac Troponin T and cardiac Troponin I are increased in patients with renal failure and this is likely to represent multifactorial pathology including cardiac dysfunction, left ventricular hypertrophy and cardiac microinfarctions. Increases in serum troponin from baseline, in patients with renal disease with acute coronary syndromes, may represent a poor prognosis. Small studies of patients with renal failure have suggested that elevation of the cardiac troponins is associated with an increased risk of cardiac death.

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“…31 However, the third-generation assay is highly specific, and cTnT has emerged as one of the most powerful predictors of mortality in patients with renal impairment, including those treated with hemodialysis. 32,33 Moreover, cTnT was associated with poor prognosis in patients with preserved renal function, suggesting that the rise and prognostic role of cTnT are independent of renal function.…”

Section: Prognostic Role Of Ctnt Monitoringmentioning

confidence: 99%

Ongoing Myocardial Injury in Stable Severe Heart Failure

Perna¹,

Macin²,

Canella³

et al. 2004

Circulation

124

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Background-The progression of chronic heart failure (CHF) is related to ongoing myocyte loss, which can be detected by cardiac troponin T (cTnT). We examined the prevalence and prognostic value of increased cTnT concentrations in serial blood specimens from patients with severe CHF. Methods and Results-Clinical, echocardiographic, and 6-minute walk test data were collected prospectively at baseline and at 1 year in 115 outpatients (mean age, 61Ϯ11 years; 75% men; 62% coronary heart disease) with CHF and a left ventricular ejection fraction Ͻ40%. Blood samples were collected at baseline and at 3, 6, and 12 months of follow-up. cTnT concentrations Ն0.02 ng/mL were considered abnormal, and a Tn index (highest cTnT measurement/0.02 ng/mL) was calculated. In 62 patients (54%), cTnT was consistently Ͻ0.02 ng/mL (group 1); 28 (24%) had a single abnormal cTnT result (group 2); and 25 (22%) had Ն2 abnormal cTnT results (group 3). At 18 months, CHF hospitalization-free survival was 63%, 46%, and 17%, respectively (Pϭ0.0001). In a Cox proportional-hazards model, hospitalization for worsening CHF in the previous year (HRϭ2.1; 95% CI, 1.1 to 4.1), functional class III-IV (HRϭ2.3; 95% CI, 1.1 to 4.6), and number of abnormal cTnT samples (HRϭ1.6; 95% CI, 1.1 to 2.4) were independently associated with prognosis. A cTnT rise of 0.020 ng/mL in any sample was associated with an excess of 9% (95% CI, 1% to 18%) in the incidence of combined end point. Conclusions-Abnormal cTnT concentrations were detected in Ͼ50% of outpatients with advanced CHF. This ongoing myocardial necrosis was a strong predictor of worsening CHF, suggesting a role of cTnT-based monitoring to identify high-risk patients.

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False-Positive Cardiac Troponin T Levels in Chronic Hemodialysis Patients

Cited by 16 publications

References 4 publications

ST Segment Elevation Pattern of Acute Myocardial Infarction Induced by Acute Pancreatitis

ST Segment Elevation Pattern of Acute Myocardial Infarction Induced by Acute Pancreatitis

Cardiac troponins and renal disease

Ongoing Myocardial Injury in Stable Severe Heart Failure

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