Prognostic value of cardiac troponin T and I elevations in renal disease patients without acute coronary syndromes: a 9-month outcome analysis.

摘要: patients are of questionable value for risk stratification, most probably due to unspecific elevations. Background. Moderate elevations cardiac troponin ( Tn) T, up levels presumably diagnostic minor Key words: haemodialysis; outcome; renal disease; tromyocardial damage, suspected be false positive ponin T; I in nearly 0.3 end-stage disease ESRD) undergoing haemodialysis (HD). It is not clear whether TnI superior TnT those patients, if diVerences between ESRD and pre-ESRD occur, Introduction what the prognostic meaning these might be. Cardiac troponins have recently been utilized Subjects methods. We examined 40 chronic renal- diagnosis acute coronary syndromes (ACS) [56.4 SD 13.9 years; 22 male, 18 provide major advantages compared conventional female) without evidence an syn- markers such as CK CKMB [1]. Troponin C drome (ACS ) at least 28 days prior investi- part troponin‐tropomyosin complex gation. status was determined by history, contractile apparatus myocytes [2]. physical examination, ECG echocardiography. (26 550 Da) T (39 000 coded diVerent Patients were divided into subgroups with HD (n=20) genes skeletal muscle, therefore (n=20). had a development cardiospecific antibodies possible. mean creatinine clearance (CC 13.45 ml/min. Tn To overcome lack specificity measured immunoassay techniques. (creatine kinase, myoglobin), two tests (TnID, TnIB), [3,4] [5‐10] developed CK/CKMB activity myoglobin (MYO) concentra- muscle shown. tions. In all 9-month follow-up The clinical measurements myocardial infarction, re-hospitalization, death evaluated large populations completed. infarction [5,11‐13] conResults. None significantly predicted comitant damage [14,15]. Reference patient outcome. did correlate CC values very low, mostly below (r<0.6). Applying lowest reported threshold detection limit. group, Troponins shown useful TnT, 0.55 TnID, perioperative AMI Nevertheless, dia0.15 TnIB. group HD, 0.2 gnostic far 1 TnID 0.1 unselected groups [11,16 ]. This mainly Conclusions. fact that severe, unstable common clinically stable angina pectoris can show tropondisease neither ins having according syndrome nor predictive concluded WHO criteria. observation led introduction increased asymptomatic ‘minor damage’ (MMD) diagnosis. These MMD worse prognosis other who