Prognostic Value of Troponin T,Troponin I, and CK-MBmass in Patients with Chronic Renal Failure

Peetz, D.; Schütt, Sabina; Sucké, Bernd; Faldum, Andreas; Wandel, Evelyn; Häfner, Gerd; Lackner, Karl J.

doi:10.1007/s00063-003-1243-3

Cited by 19 publications

(18 citation statements)

References 27 publications

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“…For studies evaluating more than 1 troponin I assay, [15][16][17] only the most common manufacturer's assay was reported. For studies evaluating more than 1 cut point, 18 -21 the most common cut point among the individual studies was used for analysis to improve between-study comparisons.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Value of Troponin T and I Among Asymptomatic Patients With End-Stage Renal Disease

et al. 2005

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Background-The prognostic usefulness of troponin enzymes in end-stage renal disease (ESRD) patients is controversial.To resolve this uncertainty of troponin as a prognostic tool, we conducted a systematic review to quantify the association between elevated troponin I or T and long-term total mortality among ESRD patients not suspected of having acute coronary syndrome. Methods and Results-We conducted an unrestricted search from the MEDLINE, EMBASE, and DARE bibliographic databases to December 2004 using the terms troponin.mp. or exp troponin and exp kidney, exp renal, exp kidney disease exp renal replacement therapy. We also manually searched review articles and bibliographies to supplement the search. Studies were included if they were prospective observational studies, used cardiac-specific troponin assays, and evaluated long-term risk of death or cardiac events for asymptomatic ESRD patients. Two authors independently abstracted data on study and patient characteristics. Studies findings were stratified according to troponin T or I levels. We used a random-effects model to pool study results and tested for heterogeneity using 2 testing and used funnel-plot inspection to evaluate the presence of publication bias. Data from 28 studies (3931 patients) published between 1999 and December 2004 were included in this review. Patients received dialysis for a median duration of 4 years, with a mean follow-up of 23 months. From the pooled analysis, elevated troponin T (Ͼ0.1 ng/mL) was significantly associated with increased all-cause mortality (relative risk, 2.64; 95% CI, 2.17 to 3.20). Although the prognostic effect sizes were all consistent with a positive relationship between troponin T and mortality, there was significant heterogeneity in the magnitude of these effect sizes (Pϭ0.015). The funnel plot showed evidence of publication bias. Elevated troponin T was also strongly associated with increased cardiac death. Studies evaluating troponin I included a wide variety of assays and differing cut points, rendering synthesis of the study findings difficult. Conclusions-Elevated troponin T (Ͼ0.1 ng/mL) identifies a subgroup of ESRD patients who have poor survival and a high risk of cardiac death despite being asymptomatic. These findings suggest that troponin T is a promising risk stratification tool and may help frame therapeutic decisions. The clinical interpretation of elevated troponin I levels, however, remain unclear, largely because of the lack of standardization of assays. (Circulation. 2005;112:3088-3096.)

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Section: Discussionmentioning

confidence: 99%

Prognostic Value of Troponin T and I Among Asymptomatic Patients With End-Stage Renal Disease

et al. 2005

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“…Some of them have shown greater cTnI levels after dialysis, others before, yet others have not detected significant changes between pre-and post-dialysis values (3,(9)(10)(11). Reasons for this variation might include the type of clearance and the membranes used in the dialysis.…”

Section: Discussionmentioning

confidence: 99%

“…Other possible causes are the absorption of TnI isoforms by the dialysis membrane and the type of methodology employed for measuring cTnI (9,11). A recent study compared pre-and post-dialysis cTnI concentrations, second and third generation immuno-assays being used.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, although recent studies demonstrate that serum or plasma cTnI is an important predictor of longterm, all-cause mortality and cardiovascular mortality in patients with ESRD, and that high concentrations of cTnI are associated with increased risk of coronary artery disease in this population (1)(2)(3), other studies conclude that cTnI has little predictive value in renal insufficiency and they do not identify it as an independent risk factor (8,9). Owing to the uncertainty about the usefulness of cTnI in ESRD, the aim of present study was to evaluate the behaviour and prognostic value of cTnI in a population of chronic haemodialysis patients.…”

Section: Introductionmentioning

confidence: 99%

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Comportamiento y valor pronóstico de la troponina I cardiaca en suero en pacientes con enfermedad renal final sometidos a hemodiálisis de largo plazo. Analisis de resultados quinquenales

Almonacid-Urrego

Cantillo-Turbay²,

Tuñón

2009

nova

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Los niveles troponina I cardiaca (cTnI) se consideran una importante herramienta de diagnóstico en los eventos coronarios agudos. Sin embargo, hay controversia sobre su sensibilidad, especificidad y valor pronóstico en la hemodiálisis (HD) de los pacientes. El objetivo de este estudio fue explorar el comportamiento y el valor pronóstico de la troponina I cardiaca en pacientes en HD. Se estudiaron treintaicuatro pacientes asintomáticos sometidos a hemodiálisis a largo plazo. Las muestras de sangre fueron tomadas al inicio del estudio (pre-y post-diálisis en suero), después de tres años (pre-diálisis en suero y plasma, con y sin la adición de anticuerpos heterófilos reactivos de bloqueo (HBR) y después de cinco años (suero pre-diálisis). Se midió la troponina I cardiaca cuantitativa con micro-partículas AxSYM cTnI de la enzima inmuno-ensayo de cTnI y la cualitativa con una prueba de un solo paso de inmuno Troponina Hexagon-cromatografía.No fue posible detectar ninguna asociación significativa entre los niveles de cTnI pre-y post-diálisis. La comparación de los resultados de la heparina de suero y plasma no reveló ninguna diferencia estadísticamente significativa entre el nivel de cTnI y los valores promedio para el plasma y suero con y sin la adición de HBR.Las concentraciones cTnI en las muestras sin HBR añadido fueron más bajas que en aquellas con HBR, pero no se observó diferencia estadísticamente significativa entre la media de cTnI y la media de las muestras con y sin adición de HBR. Durante el estudio, el 35,2% de la población murió. Se observó una asociación positiva entre los valores de cTnI en los pacientes que aún viven y en los pacientes que murieron a causa de la miocardiopatía isquémica (p = 0,039). El crudo riesgo de muerte por enfermedad cardiovascular se ha multiplicado por ocho (el intervalo de 95% de confianza estando entre 1,2 y 51,1) en pacientes con una concentración de cTnI superior a 0,04 ng/ml. Los niveles de cTnI pueden reflejar la isquemia miocárdica oculta e identificar los pacientes en hemodiálisis que se enfrentan a un mayor riesgo de muerte.

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“…Firm evidence had accumulated that patients with severely reduced glomerular filtration rate and in particular patients on hemodialysis have increased plasma concentrations of cTn. While moderately elevated cTn beyond the URL in an individual renal patient was not necessarily diagnostic for myocardial infarction it was clearly associated with a poorer cardiovascular prognosis [17,18]. Currently, it is unknown whether this holds true with the hs-cTn assays [19].…”

Section: This Issue Of Clinical Chemistry and Laboratory Medicinementioning

confidence: 99%

High-sensitivity assays for cardiac troponins

Lackner

2015

Clinical Chemistry and Laboratory Medicine (CCLM)

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(CCLM) devotes a large section to the cardiac troponins (cTn) and in particular to the impact of the novel high sensitivity (hs) assays on clinical practice. Furthermore, several articles deal with known or novel pitfalls of hs-cTn in clinical diagnostics.While there is no doubt that the hs-cTn assays constitute a significant analytical step forward, they obviously introduced a momentum of uncertainty for many clinicians. Perhaps this is common to all innovations which force people to leave their well known firm ground. In the case of hs-Tn the major changes relate to the rule-in and rule-out criteria of myocardial infarction. Already the first studies have provided robust data that early rule-out can be substantially improved and the ESC has adapted their guidelines accordingly [1][2][3]. However, many clinicians feel that rule-in has become more complicated not to say confusing. Since many of the traditional cTn assays had cut-offs far beyond the 99th percentile due to their relatively high limit of quantitation (LoQ) [4], the positive predictive value of an abnormal test result was high. In fact, it is important to keep in mind that the upper reference limit (URL) of most assays was not the 99th percentile but a significantly higher plasma concentration of cTn [4]. The novel hs-cTn assays provide reliable results between their 99th percentile and the cut-off of their predecessor tests [5]. This opens up a gray zone which was neglected in the past. Interpretation and clinical consequences derived from hs-cTn results in this gray zone are currently debated. For some but not all assays we have thorough data about positive and negative predictive values depending on individual patient characteristics and timing of cTn plasma concentrations [6]. Another issue that is profoundly influenced by the hs-cTn assays is the analysis of changes in cTn plasma concentrations over time and their diagnostic potential [7]. Many traditional cTn assays were not able to provide reliable time courses close to the 99th percentile. Therefore, the use of Δ-cTn generated with these assays was very limited. With the novel hs-cTn assays it is possible to reliably determine Δ-cTn even below the 99th percentile. However, the meaning of such changes is not clear and we will need more data from dedicated studies to interpret them [8][9][10].In order to better appreciate these problems, it is helpful to remember the reasons for the new definition of myocardial infarction introduced in the year 2000 [11]. In the past we tended to differentiate between stable angina, unstable angina, and myocardial infarction. In the 1990s it became clear that patients with unstable angina with elevated cTn concentration had the same risk of adverse outcomes as patients with what was then considered myocardial infarction, while patients without cTn elevations had a much better prognosis [12]. Interestingly, this subgroup of unstable angina patients also benefited from the same interventions as patients with myocardial infarction [13]. This observation finally l...

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Prognostic Value of Troponin T,Troponin I, and CK-MBmass in Patients with Chronic Renal Failure

Abstract: TnT and a known coronary heart disease are relevant, independent risk factors in patients with chronic renal failure undergoing long-term hemodialysis.

Cited by 19 publications

References 27 publications

Prognostic Value of Troponin T and I Among Asymptomatic Patients With End-Stage Renal Disease

Prognostic Value of Troponin T and I Among Asymptomatic Patients With End-Stage Renal Disease

Comportamiento y valor pronóstico de la troponina I cardiaca en suero en pacientes con enfermedad renal final sometidos a hemodiálisis de largo plazo. Analisis de resultados quinquenales

High-sensitivity assays for cardiac troponins

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