Circulation. 2002;106:2941-2945
Published online before print November 11, 2002, doi: 10.1161/01.CIR.0000041254.30637.34
Published online before print November 11, 2002, doi: 10.1161/01.CIR.0000041254.30637.34
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(Circulation. 2002;106:2941.)
© 2002 American Heart Association, Inc.
Clinical Investigation and Reports |
Predictive Value of Cardiac Troponin I and T for Subsequent Death in End-Stage Renal Disease
From the Departments of Laboratory Medicine and Pathology (F.S.A., M.M.M.) and Medicine (C.A.H.), Hennepin County Medical Center, University of Minnesota School of Medicine, Minneapolis, Minn, and Biostatistical Consulting (L.A.P.), Minot, ND.
Correspondence to Fred S. Apple, PhD, Hennepin County Medical Center, 701 Park Ave, Clinical Laboratories MC 812, Minneapolis, MN 55415. E-mail fred.apple{at}co.hennepin.mn.us
Background— This study determined the prevalence of increased cardiac troponin I (cTnI) and T (cTnT) in end-stage renal disease (ESRD) patients and whether an increased troponin was predictive of death.
Methods and Results— Serum was obtained from 733 ESRD patients and measured for cTnI and cTnT. Relative risks were estimated using Cox proportional hazards regressions univariately and adjusted for age, time on dialysis, and coronary artery disease. Kaplan-Meier curves compared time to event data between groups. Greater percentages of patients had an increased cTnT versus cTnI at each cutoff, as follows: 99th percentile, 82% versus 6%; 10% coefficient of variation, 53% versus 1.0%; and receiver operator characteristic, 20% versus 0.4%. Increased versus normal cTnT was predictive of increased mortality using all cutoffs and only above the 99th percentile for cTnI. Two-year cumulative mortality rates increased (P<0.001) with changes in cTnT from normal (<0.01 µg/L, 8.4%) to small (
0.01 to <0.04 µg/L, 26%), moderate (0.04 to <0.1 µg/L, 39%), and large (0.1 µg/L, 47%) increases. Two-year mortalities were 30% for cTnI <0.1 µg/L and 52% if 0.1 µg/L. Univariate and adjusted relative risks of death associated with elevated (>99th percentile) cTnT were 5.0 (CI, 2.5 to 10; P<0.001) and 3.9 (CI, 1.9 to7.9; P<0.001) and cTnI were 2.0 (CI, 1.3 to 3.3; P=0.008) and 2.1 (CI, 1.3 to 3.3; P=0.007). Age, coronary artery disease, and time on dialysis were also independent predictors of mortality.
Conclusions— Increases in cTnT and cTnI in ESRD patients show a 2- to 5-fold increase in mortality, with a greater number of patients having an increased cTnT.
Key Words: mortality • cardiovascular diseases • myocardial infarction • kidney
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|
|
|
 |
|
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|
|
|
|
|
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|
|
|
|
 |
|
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|
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|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
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|
|
|
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|
|
|
|
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|
|
|
 |
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
 C-K Wong and H D White Implications of the new definition of myocardial infarction Postgrad. Med. J., September 1, 2005; 81(959): 552 - 555. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
R. Gupta, Y. Birnbaum, and B. F. Uretsky The renal patient with coronary artery disease: Current concepts and dilemmas J. Am. Coll. Cardiol., October 6, 2004; 44(7): 1343 - 1353. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S Sharma, P G Jackson, and J Makan Cardiac troponins J. Clin. Pathol., October 1, 2004; 57(10): 1025 - 1026. [Full Text] [PDF]
|
|
|
|
 |
|
 A. Dispenzieri, M. A. Gertz, R. A. Kyle, M. Q. Lacy, M. F. Burritt, T. M. Therneau, J. P. McConnell, M. R. Litzow, D. A. Gastineau, A. Tefferi, et al. Prognostication of survival using cardiac troponins and N-terminal pro-brain natriuretic peptide in patients with primary systemic amyloidosis undergoing peripheral blood stem cell transplantation Blood, September 15, 2004; 104(6): 1881 - 1887. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Boulier, I. Jaussent, N. Terrier, F. Maurice, J.-P. Rivory, L. Chalabi, A.-M. Boularan, C. Delcourt, A.-M. Dupuy, B. Canaud, et al. Measurement of circulating troponin Ic enhances the prognostic value of C-reactive protein in haemodialysis patients Nephrol. Dial. Transplant., September 1, 2004; 19(9): 2313 - 2318. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Giannitsis, H. A. Katus, J. H.C. Diris, C. M. Hackeng, M. P. van Dieijen-Visser, J. P. Kooman, Y. M. Pinto, and W. T. Hermens Troponin T Release in Hemodialysis Patients * Response Circulation, July 20, 2004; 110(3): e25 - e26. [Full Text] [PDF]
|
|
|
|
|
|
M. Panteghini Role and importance of biochemical markers in clinical cardiology Eur. Heart J., July 2, 2004; 25(14): 1187 - 1196. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. J Fox, C. Grimm, and N. P Curzen Raised troponin T in acute cholecystitis J R Soc Med, April 1, 2004; 97(4): 179 - 179. [Full Text] [PDF]
|
|
|
|
|
|
J. Ishii, W. Cui, F. Kitagawa, T. Kuno, Y. Nakamura, H. Naruse, Y. Mori, T. Ishikawa, Y. Nagamura, T. Kondo, et al. Prognostic Value of Combination of Cardiac Troponin T and B-Type Natriuretic Peptide after Initiation of Treatment in Patients with Chronic Heart Failure Clin. Chem., December 1, 2003; 49(12): 2020 - 2026. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. V. Luepker, F. S. Apple, R. H. Christenson, R. S. Crow, S. P. Fortmann, D. Goff, R. J. Goldberg, M. M. Hand, A. S. Jaffe, D. G. Julian, et al. Case Definitions for Acute Coronary Heart Disease in Epidemiology and Clinical Research Studies: A Statement From the AHA Council on Epidemiology and Prevention; AHA Statistics Committee; World Heart Federation Council on Epidemiology and Prevention; the European Society of Cardiology Working Group on Epidemiology and Prevention; Centers for Disease Control and Prevention; and the National Heart, Lung, and Blood Institute Circulation, November 18, 2003; 108(20): 2543 - 2549. [Full Text] [PDF]
|
|
|
|
|
|
P O Collinson and P J Stubbs Are troponins confusing? Heart, November 1, 2003; 89(11): 1285 - 1287. [Full Text] [PDF]
|
|
|
|
 |
|
 C. A. Herzog How to Manage the Renal Patient with Coronary Heart Disease: The Agony and the Ecstasy of Opinion-Based Medicine J. Am. Soc. Nephrol., October 1, 2003; 14(10): 2556 - 2572. [Full Text] [PDF]
|
|
|
|
|
|
C. deFilippi, S. Wasserman, S. Rosanio, E. Tiblier, H. Sperger, M. Tocchi, R. Christenson, B. Uretsky, M. Smiley, J. Gold, et al. Cardiac Troponin T and C-Reactive Protein for Predicting Prognosis, Coronary Atherosclerosis, and Cardiomyopathy in Patients Undergoing Long-term Hemodialysis JAMA, July 16, 2003; 290(3): 353 - 359. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. E. Lipshultz, M. J. G. Somers, S. R. Lipsitz, S. D. Colan, K. Jabs, and N. Rifai Serum Cardiac Troponin and Subclinical Cardiac Status in Pediatric Chronic Renal Failure Pediatrics, July 1, 2003; 112(1): 79 - 86. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Herrmann, J. Scharhag, M. Miclea, A. Urhausen, W. Herrmann, and W. Kindermann Post-Race Kinetics of Cardiac Troponin T and I and N-Terminal Pro-Brain Natriuretic Peptide in Marathon Runners Clin. Chem., May 1, 2003; 49(5): 831 - 834. [Full Text] [PDF]
|
|
|
|
|
|
C. W. Hamm, E. Giannitsis, and H. A. Katus Cardiac Troponin Elevations in Patients Without Acute Coronary Syndrome Circulation, December 3, 2002; 106(23): 2871 - 2872. [Full Text] [PDF]
|
|