Over time, high-sensitivity TnT replaces NT-proBNP as the most powerful predictor of death in patients with dialysis-dependent chronic renal failure

McGill, David; Talaulikar, Girish; Potter, Julia M.; Koerbin, Gus; Hickman, Peter E.

doi:10.1016/j.cca.2010.03.004

Cited by 78 publications

(78 citation statements)

References 13 publications

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“…The greater sensitivity of the hs-cTnT assay has been shown to improve our ability to diagnose MI, in comparison with the older assays, in the non-renal disease population (11)(12)(13)(14). In line with our current data, hs-cTnT also appears to be a better predictor of outcome than the older assays for patients on dialysis (25 ).…”

Section: Discussionsupporting

confidence: 77%

High-Sensitivity Troponin as a Predictor of Cardiac Events and Mortality in the Stable Dialysis Population

et al. 2014

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BACKGROUND:High-sensitivity cardiac troponin T (hs-cTnT) is a biomarker used in diagnosing myocardial injury. The clinical utility and the variation of this biomarker over time remain unclear in hemodialysis (HD) and peritoneal dialysis (PD) patients. We sought to determine whether hs-cTnT concentrations were predictive of myocardial infarction (MI) and death and to examine hs-cTnT variability over a 1-year period.

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Section: Discussionsupporting

confidence: 77%

High-Sensitivity Troponin as a Predictor of Cardiac Events and Mortality in the Stable Dialysis Population

et al. 2014

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“…Troponin positivity is known to be an independent predictor of adverse outcomes in many different populations, including patients with acute coronary syndrome (ACS), 1,2 congestive heart failure, 3,4 arrhythmia, 5 pulmonary embolism, 6,7 chronic obstructive pulmonary disease, 8 renal failure, 9,10 sepsis, 11 and intracranial hemorrhage. 12,13 Postprocedure troponin positivity has been associated with worse outcomes following percutaneous coronary intervention 14 and both cardiac 15,16 and noncardiac surgery.…”

Section: Ré Sumémentioning

confidence: 99%

Outcomes of non–acute coronary syndrome patients discharged from the emergency department with troponin positivity

Brunner

Scheuermeyer

Grafstein

et al. 2014

CJEM

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Background: Cardiac troponin elevation portends a worse prognosis in diverse patient populations. The significance of troponin elevation in patients discharged from emergency departments (EDs) without inpatient admission is not well known. Methods: Patients without a diagnosis of acute coronary syndrome discharged from two EDs between April 1, 2006, and December 31, 2007, with an abnormal cardiac troponin (troponin positive [TP]) were compared to a troponin-negative (TN) cohort matched for age, sex, and primary discharge diagnosis. Outcomes were obtained by linking with a regional ED and a provincial vital statistics database and adjusted for the following: estimated glomerular filtration rate, do-notresuscitate status, history of coronary artery disease, Canadian Triage and Acuity Scale, and left ventricular hypertrophy on electrocardiography. The primary outcome was a composite of death or admission to hospital within 1 year. Results: Our total cohort (n 5 344) consisted of 172 TP and 172 TN patients. In the univariate analysis, TP patients had a higher rate of the primary outcome (OR 3.2, 95% CI 2.1-5.0, p , 0.001) and both of its components (p , 0.001). After adjusting for covariates, positive troponin remained an independent predictor of the primary outcome (OR 2.1, 95% CI 1.3-3.4, p 5 0.005) and inpatient admission (OR 2.0, 95% CI 1.2-3.4, p 5 0.006). There was no significant difference in death (OR 1.3, 95% CI 0.6-2.9, p 5 0.5) after adjustment. Conclusions: A positive troponin assay during ED stay in discharged patients is an independent marker for risk of subsequent admission. Our findings suggest that the prognostic power of an abnormal troponin extends to patients discharged from the ED.

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“…New high-sensitivity (hs) cardiac troponin assays with detection limits 10 -100 times lower than currently available commercial assays meet this imprecision guideline (8 ). Recently, cardiac troponin T (cTnT) measured in dialysis-dependent patients by an hs assay was shown to be the most powerful predictor of long-term mortality compared to other biomarkers and clinical risk predictors (9 ). However, in nondialysis-dependent asymptomatic patients with CKD, both quantification of concentrations and correlation with underlying cardiovascular pathology is unknown.…”

confidence: 99%

Interpreting Cardiac Troponin Results from High-Sensitivity Assays in Chronic Kidney Disease without Acute Coronary Syndrome

deFilippi¹,

Seliger²,

Kelley

et al. 2012

Clinical Chemistry

127

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BACKGROUND Quantification and comparison of high-sensitivity (hs) cardiac troponin I (cTnI) and cTnT concentrations in chronic kidney disease (CKD) have not been reported. We examined the associations between hs cTnI and cTnT, cardiovascular disease, and renal function in outpatients with stable CKD. METHODS Outpatients (n = 148; 16.9% with prior myocardial infarction or coronary revascularization) with an estimated glomerular filtration rate (eGFR) of <60 mL · min−1 · (1.73 m2)−1 had serum cTnI (99th percentile of a healthy population = 9.0 ng/L), and cTnT (99th percentile = 14 ng/L) measured with hs assays. Left ventricular ejection fraction (LVEF) and mass were assessed by echocardiography, and coronary artery calcification (CAC) was determined by computed tomography. Renal function was estimated by eGFR and urine albumin/creatinine ratio (UACR). RESULTS The median (interquartile range) concentrations of cTnI and cTnT were 6.3 (3.4–14.4) ng/L and 17.0 (11.2–31.4) ng/L, respectively; 38% and 68% of patients had a cTnI and cTnT above the 99th percentile, respectively. The median CAC score was 80.8 (0.7–308.6), LV mass index was 85 (73–99) g/m2, and LVEF was 58% (57%–61%). The prevalences of prior coronary disease events, CAC score, and LV mass index were higher with increasing concentrations from both hs cardiac troponin assays (P < 0.05 for all). After adjustment for demographics and risk factors, neither cardiac troponin assay was associated with CAC, but both remained associated with LV mass index as well as eGFR and UACR. CONCLUSIONS Increased hs cTnI and cTnT concentrations are common in outpatients with stable CKD and are influenced by both underlying cardiac and renal disease.

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Over time, high-sensitivity TnT replaces NT-proBNP as the most powerful predictor of death in patients with dialysis-dependent chronic renal failure

Cited by 78 publications

References 13 publications

High-Sensitivity Troponin as a Predictor of Cardiac Events and Mortality in the Stable Dialysis Population

High-Sensitivity Troponin as a Predictor of Cardiac Events and Mortality in the Stable Dialysis Population

Outcomes of non–acute coronary syndrome patients discharged from the emergency department with troponin positivity

Interpreting Cardiac Troponin Results from High-Sensitivity Assays in Chronic Kidney Disease without Acute Coronary Syndrome

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