Value of troponin T as a screening test of cardiac structure and function in chronic kidney disease.

Autor:	Nasr FM; Intensive Care Department, Theodor Bilharz Research Institute (TBRI), Jizah, Egypt., Metwaly A; Intensive Care Department, Theodor Bilharz Research Institute (TBRI), Jizah, Egypt., Khalik AA; Intensive Care Department, Theodor Bilharz Research Institute (TBRI), Jizah, Egypt., Raafat M; Nephrology Department, Theodor Bilharz Research Institute, Jizah, Egypt., Nabil M; Nephrology Department, Theodor Bilharz Research Institute, Jizah, Egypt., Kamel L; Clinical Chemistry Department, Theodor Bilharz Research Institute, Jizah, Egypt., Elsheikh N; Nephrology Department, Theodor Bilharz Research Institute, Jizah, Egypt.
Jazyk:	angličtina
Zdroj:	Global cardiology science & practice [Glob Cardiol Sci Pract] 2021 Dec 31; Vol. 2021 (4), pp. e202126. Date of Electronic Publication: 2021 Dec 31 (Print Publication: 2021).
DOI:	10.21542/gcsp.2021.26
Abstrakt:	Background: Cardiovascular disease starts early in the course of chronic kidney disease (CKD) and is the leading cause of death in patients with end-stage renal disease. Since high-sensitivity cardiac troponin T (hs-cTnT) can detect much lower levels of myocardial injury than conventional assays, it may be useful for studying the earliest stages of heart disease in patients with CKD. Objective: To evaluate the association of circulating hs-cTnT with LV structural and functional abnormalities detected by echocardiography among dialysis dependent and non-dialysis dependent CKD patients. Methods: This study was conducted on 107 subjects divided into three groups. Group I consisted of CKD patients on conservative treatment ( n  = 42), Group II: hemodialysis patients ( n  = 42), Group III: control group: age and sex matched healthy volunteers ( n  = 23). All subjects were subjected to clinical examination, biochemical evaluation including estimation of hs-cTnT and Echo-Doppler study of cardiac structure and function. Results: There was a significant increase in LAV ( p  < 0.01), LVM ( p  < 0.01) in both patient groups compared to the control group. Mitral annular plane systolic excursion (MAPSE) was significantly decreased in both patient groups compared to the control group ( p  < 0.01, p  < 0.05) and in group I compared to group II ( p  < 0.05) with a significant decrease in S velocity in group I compared to groups II and III ( p  < 0.01). There was a significant decrease in Vp ( p  < 0.01) with a significant increase in AEF ( p  < 0.01) in both patients' groups compared to the control group and AEF was significantly increased in group II compared to group I ( p  < 0.01). Ea velocity and Ea/Aa decreased significantly ( p  < 0.01) with significant increase in Aa velocity ( p  < 0.05, p  < 0.01), E/Ea ( p  < 0.01) and E/Vp ( p  < 0.05) in both patient groups compared to the control group. There was a significant increase in hs-cTnT levels in both patient groups compared to the control group ( P  < 0.01). We found a positive correlation between hs-cTnT levels and LAV ( r  = 0.291, p  < 0.03), IVST ( r  = 0.374, p  < 0.004), PWT ( r  = 0.309, p  < 0.02), LVM ( r  = 0.282, p  < 0.03), A wave velocity ( r  = 0.271, p  < 0.04), E/Ea ( r  = 0.506, p  < 0.0001), PCWP ( r  = .507, p  < 0.0001) and a negative correlation between hs-cTnT and MAPSE ( r  =  - 0.300, p  < 0.02), S wave velocity ( r  =  - 0.259, p  < 0.05), Ea ( r  =  - 626, p  < 0.0001), Ea/Aa ( r  =  - 0.543, p  < 0.0001). Troponin at the cut-off value of >5 ng/L, revealed 100% sensitivity and 95% specificity with areas under curve (AUC) of 0.998 and accuracy of 95.65% ( P  < 0.01) for discrimination of Group I vs control group and 76.2% sensitivity and 95.7% specificity with AUC 0.796 and accuracy 71.84% ( P  < 0.01) for discrimination of group II vs control group. Conclusion: Structural and functional cardiac abnormalities are common in CKD patients. Serum hs-cTnT levels increased in CKD patients and was associated with LVH, LAV and some of the echocardiographic parameters of LV systolic and diastolic dysfunction. Our research suggests that hs-cTnT levels may be important for early screening of cardiac structure and function in CKD patients to provide evidence for early intervention. Competing Interests: The authors declare no conflicts of interest. FundingThe authors received no specific funding for this research. (Copyright ©2021 The Author(s).)
Databáze:	MEDLINE
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