scholarly journals High-Sensitive Cardiac Troponin T for Prediction of Cardiovascular Outcomes in Stable Maintenance Hemodialysis Patients: A 3-Year Prospective Study

2021 ◽  
pp. 1-11
Author(s):  
Linlin Sun ◽  
Yonglan Wang ◽  
Nan Zhang ◽  
Xinmiao Xie ◽  
Miao Ding ◽  
...  
Keyword(s):  
Cardiac Troponin ◽  
Prognostic Value ◽  
Troponin T ◽  
Hemodialysis Patients ◽  
Maintenance Hemodialysis ◽  
Cardiac Troponin T ◽  
All Cause Mortality ◽  
Echocardiographic Parameters ◽  
Stable Maintenance

<b><i>Background:</i></b> Hemodialysis patients, who are often excluded from cardiovascular (CV) clinical trials, are associated with higher CV morbidity and mortality. The risk stratification scheme for these patients is lacking. Therefore, this investigation examined the independent CV prognostic value of high-sensitive cardiac troponin T (hs-cTnT) and added prognostic value over echocardiographic parameters and other clinical risk predictors in asymptomatic stable maintenance hemodialysis (MHD) patients. <b><i>Methods:</i></b> 181 patients with end-stage renal disease undergoing MHD were eligible from the dialysis center of Tongren Hospital, Shanghai Jiao Tong University School of Medicine between October 2017 and September 2018. These patients were followed until September 2020 or until death. The median follow-up was 31 (IQR: 21–33) months. Outcome measures were all-cause mortality, first fatal or nonfatal CV events (CVEs), and 4-point composite major adverse CVEs (MACE). We performed multivariable Cox regression analysis using demographic, clinical, laboratory, and echocardiographic data to identify predictors of CV outcomes. We also evaluated the increased discriminative value associated with the addition of echocardiographic parameters and hs-cTnT using net reclassification improvement (NRI) and integrated discrimination improvement (IDI). <b><i>Results:</i></b> During follow-up, 37 patients died, 84 patients suffered one or more CVEs, and 78 patients developed 4-point MACE. In univariable analyses, age, dialysis vintage, diastolic blood pressure, parathyroid hormone concentrations, hs-cTnT, B-type natriuretic peptide, left ventricular mass index (LVMI), and <i>E</i>/<i>E</i>′ predicted all end points. hs-cTnT remained a strong predictor for each end point in multivariate analysis, whereas LVMI and <i>E</i>/<i>E</i>′ did not. The addition of hs-cTnT on top of clinical and echocardiographic variables was associated with improvements in reclassification for CVEs (NRI = 44.6% [15.9–74.3%], IDI = 15.9% [5.7–31.0%], all <i>p</i> &#x3c; 0.001), all-cause mortality (NRI = 35.5% [10.1–50.2%], <i>p</i> &#x3c; 0.001, IDI = 4.4% [1.3–8.5%], <i>p</i> = 0.005), and 4-point MACE (NRI = 47.2% [16.1–64.9%], <i>p</i> &#x3c; 0.001, IDI = 16.9% [5.5–37.3%], <i>p</i> = 0.005). Adding echocardiographic variables on top of clinical variables and hs-cTnT was not associated with significant improvements in NRI and IDI (all <i>p</i> &#x3e; 0.05). <b><i>Conclusions:</i></b> Our data suggest that hs-cTnT is a powerful independent predictor of CV outcome and all-cause mortality in stable MHD patients. The additional use of echocardiography for improvement of risk stratification is not supported by our results.

scholarly journals Prognostic Value of Cardiac Troponin T Is Independent of Inflammation, Residual Renal Function, and Cardiac Hypertrophy and Dysfunction in Peritoneal Dialysis Patients

2007 ◽  
Vol 53 (5) ◽  
pp. 882-889 ◽  
Author(s):  
Angela Yee-Moon Wang ◽  
Christopher Wai-Kei Lam ◽  
Mei Wang ◽  
Iris Hiu-Shuen Chan ◽  
William B Goggins ◽  
...  
Keyword(s):  
Renal Function ◽  
Peritoneal Dialysis ◽  
Cardiac Troponin ◽  
Cardiovascular Events ◽  
Prognostic Value ◽  
Troponin T ◽  
Residual Renal Function ◽  
Cardiovascular Death ◽  
Cardiac Troponin T ◽  
All Cause Mortality

Abstract Background: We investigated whether cardiac troponin T (cTnT) independently predicted outcome and added prognostic value over other clinical risk predictors in chronic peritoneal dialysis (PD) with end-stage renal disease. Methods: Baseline cTnT, echocardiography, indices of dialysis adequacy, and biochemical characteristics were assessed in 238 chronic PD patients who were followed prospectively for 3 years or until death. Results: Using multivariable Cox regression analysis, cTnT remained predictive of all-cause mortality [hazard ratio 4.43, 95% CI 1.87–10.45, P = 0.001], cardiovascular death (4.12, 1.29–13.17, P = 0.017), noncardiovascular death (8.06, 1.86–35.03, P = 0.005), and fatal and nonfatal cardiovascular events (CVEs) (3.59, 1.48–8.70, P = 0.005) independent of background coronary artery disease, inflammation, residual renal function, left ventricular hypertrophy, and systolic dysfunction. cTnT alone had better predictive value than C-reactive protein (CRP) alone for mortality [area under the ROC curve (AUC) 0.774 vs 0.691; P = 0.089] and first CVE (AUC 0.711 vs 0.593; P = 0.009) at 3 years. Survival models including age, sex, and clinical, biochemical, and echocardiographic characteristics yielded AUCs of 0.813 (95% CI, 0.748–0.877), 0.800 (95% CI, 0.726–0.874), and 0.769 (95% CI, 0.708–0.830), respectively, in relation to all-cause mortality, cardiovascular death, and fatal and nonfatal cardiovascular events. After addition of cTnT, AUCs of the above models increased significantly to 0.832 (95% CI, 0.669–0.894; P = 0.0037), 0.810 (95% CI, 0.739–0.883; P = 0.0036), and 0.780 (95% CI, 0.720–0.840; P = 0.0002), respectively; no AUCs increased when CRP was added. Conclusions: cTnT is an independent predictor of long-term mortality, cardiovascular death and events, and noncardiovascular death in PD patients.

scholarly journals High-Sensitivity Cardiac Troponin T is A Risk Factor for Major Adverse Cardiovascular Events and All-Cause Mortality: 9.5 Year Follow-up Study

2020 ◽  
Author(s):  
Xiaona Wang ◽  
Ruihua Cao ◽  
Xu Yang ◽  
Wenkai Xiao ◽  
Yun Zhang ◽  
...  
Keyword(s):  
Cardiac Troponin ◽  
Cardiovascular Events ◽  
Troponin T ◽  
High Sensitivity ◽  
Major Adverse Cardiovascular Events ◽  
Cardiac Troponin T ◽  
Follow Up Study ◽  
All Cause Mortality ◽  
Coronary Events

Abstract Background: The relationship between high-sensitivity cardiac troponin T (hs-cTnT) and different cardiovascular events has been observed in several large community studies, and the results have been controversial. However, there is currently no cross-sectional or longitudinal follow-up study on hs-cTnT in the Chinese population.Methods: We analyzed the association of plasma hs-cTnT levels with major adverse cardiovascular events and all-cause mortality in 1325 subjects from a longitudinal follow-up community-based population in Beijing, China.Results: In the Cox proportional hazards models analysis, the risk of MACE increased with the increase of hs-cTnT levels (HR, 1.223, 95% CI, 1.054–1.418, P = 0.008). Increased hs-cTnT levels were associated with coronary events (HR, 1.391, 95% CI, 1.106–1.749, P = 0.005) in Model 4. Cox proportional risk regression model analysis revealed that increased hs-cTnT levels were associated with an increased risk of mortality (HR, 1.763, 95% CI, 1.224–2.540, P = 0.002), even after adjusting hs-CRP and NT-proBNP. The area under the ROC curve for predicting MACE was 0.559 (95% CI, 0.523–0.595, P = 0.001). The areas under the ROC curve for predicting coronary events and mortality were 0.629 (95% CI, 0.580–0.678, P < 0.001) and 0.644 (95% CI, 0.564–0.725, P < 0.001), respectively.Conclusions: Our findings in the Chinese cohort support that hs-cTnT is a risk factor for major adverse cardiovascular events and all-cause mortality.

scholarly journals Repeated Measurements of Cardiac Troponin T and N-Terminal Pro-B-Type Natriuretic Peptide to Assess Long-Term Mortality Risk in Subjects with Osteoarthritis

Biomolecules ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 230
Author(s):  
Martin Rehm ◽  
Gisela Büchele ◽  
Rolf Erwin Brenner ◽  
Klaus-Peter Günther ◽  
Hermann Brenner ◽  
...  
Keyword(s):  
Mortality Risk ◽  
Cardiac Troponin ◽  
Prognostic Value ◽  
Troponin T ◽  
Repeated Measurements ◽  
Cardiac Troponin T ◽  
One Year ◽  
Long Term Mortality

Osteoarthritis (OA) is associated with higher cardiovascular mortality risk. High-sensitivity cardiac troponin T (hs-cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) are well-characterized prognostic cardiac markers. We aimed to describe the changes in biomarkers measured one year apart in a cohort of 347 subjects with OA who underwent hip or knee replacement surgery in 1995/1996 and to analyze the prognostic value of repeated measurements for long-term mortality. During a median follow-up of 19 years, 209 (60.2%) subjects died. Substantial changes in cardiac biomarkers, especially for NT-proBNP, and an independent prognostic value of NT-proBNP for long-term mortality were found for both baseline measurement concentration (hazard ratio (HR) 1.32, 95% confidence interval (CI) (1.13–1.55)) and follow-up measurement concentration (HR 1.39, 95% CI 1.18–1.64) (all HR per standard deviation increase after natural log-transformation). Baseline concentrations were correlated with follow-up concentrations of NT-proBNP and no longer showed prognostic value when included simultaneously in a single model (HR 1.08, 95% CI 0.86–1.37), whereas the estimate for the one-year measurement remained robust (HR 1.31, 95% CI 1.04–1.66). Therefore, no significant additional benefit of repeated NT-proBNP measurements was found in this cohort, facilitating the use of a single NT-proBNP measurement as a stable prognostic marker.

scholarly journals High-Sensitivity Cardiac Troponin T Is a Risk Factor for Major Adverse Cardiovascular Events and All-Cause Mortality: A 9.5-Year Follow-Up Study

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Xiaona Wang ◽  
Peiqi Wang ◽  
Ruihua Cao ◽  
Xu Yang ◽  
Wenkai Xiao ◽  
...  
Keyword(s):  
Cardiac Troponin ◽  
Cardiovascular Events ◽  
Troponin T ◽  
High Sensitivity ◽  
Major Adverse Cardiovascular Events ◽  
Cardiac Troponin T ◽  
Follow Up Study ◽  
All Cause Mortality ◽  
Coronary Events

Background. The relationship between high-sensitivity cardiac troponin T (hs-cTnT) and different cardiovascular events has been observed in several large community studies, and the results have been controversial. However, there is currently no cross-sectional or longitudinal follow-up study on hs-cTnT in the Chinese population. Methods. We analyzed the association of plasma hs-cTnT levels with major adverse cardiovascular events (MACEs) and all-cause mortality in 1325 subjects from a longitudinal follow-up community-based population in Beijing, China. Results. In the Cox proportional hazards models analysis, the risk of MACEs increased with the increase of hs-cTnT levels (HR, 1.223, 95% CI, 1.054–1.418, P = 0.008 ). Increased hs-cTnT levels were associated with coronary events (HR, 1.391, 95% CI, 1.106–1.749, P = 0.005 ) in Model 4. Cox proportional risk regression model analysis revealed that increased hs-cTnT levels were associated with an increased risk of mortality (HR, 1.763, 95% CI, 1.224–2.540, P = 0.002 ), even after adjusting hs-CRP and NT-proBNP. The area under the ROC curve for predicting MACEs was 0.559 (95% CI, 0.523–0.595, P = 0.001 ). The areas under the ROC curve for predicting coronary events and mortality were 0.629 (95% CI, 0.580–0.678, P < 0.001 ) and 0.644 (95% CI, 0.564–0.725, P < 0.001 ), respectively. Conclusions. Our findings in the Chinese cohort support that hs-cTnT is a risk factor for major adverse cardiovascular events and all-cause mortality.

scholarly journals Independent Value of Cardiac Troponin T and Left Ventricular Global Longitudinal Strain in Predicting All-Cause Mortality among Stable Hemodialysis Patients with Preserved Left Ventricular Ejection Fraction

2014 ◽  
Vol 2014 ◽  
pp. 1-12 ◽  
Author(s):  
Junne-Ming Sung ◽  
Chi-Ting Su ◽  
Yu-Tzu Chang ◽  
Yu-Ru Su ◽  
Wei-Chuan Tsai ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Cardiac Troponin ◽  
Longitudinal Strain ◽  
Troponin T ◽  
Global Longitudinal Strain ◽  
Hemodialysis Patients ◽  
Left Ventricular ◽  
Cardiac Troponin T ◽  
Clinical Parameters ◽  
Echocardiographic Parameters

Using a speckle-tracking echocardiography (STE), we recently demonstrated that a left ventricular (LV) global longitudinal strain (GLS) ≥ −15% and the serum cardiac troponin T (cTnT) concentration are associated with mortality in stable hemodialysis patients with preserved LV ejection fraction (LVEF). In this study, we explored the relationship between cTnT and echocardiographic parameters and evaluated whether the prognostic value provided by cTnT is independent of a GLS ≥ −15% and vice versa. Eighty-eight stable hemodialysis patients with preserved LVEF were followed for 31 months. STE studies and measurements of cTnT were performed at baseline. CTnT concentration had a modest correlation with GLS (rs=0.44;P<0.001) but had a weak or nonsignificant correlation with other echocardiographic parameters. Adjusting for clinical parameters, hazard ratios for each increase of 0.01 ng/mL in cTnT, and a GLS ≥ −15% on mortality were 1.13 (P=0.009) and 3.09 (P=0.03) without significant interaction between cTnT and GLS ≥ −15%. In addition, an increased cTnT concentration, a GLS ≥ −15%, or their combination showed significant additional predictive value for mortality when included in models consisting of clinical parameters. Therefore, both cTnT and a GLS ≥ −15% are independent predictors of mortality and are useful for risk stratification.

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