Mallamaci Francesca, Zoccali Carmine, Parlongo Saverio, Tripepi Giovanni, Benedetto Francesco A, Cutrupi Sebastiano, Bonanno Grazia, Fatuzzo Pasquale, Rapisarda Francesco, Seminara Giuseppe, Stancanelli Benedetta, Bellanuova Ignazio, Cataliotti Alessando, Malatino Lorenzo S
CNR Centre of Clinical Physiology and Division of Nephrology, Reggio Calabria, Italy.
Kidney Int. 2002 Nov;62(5):1884-90. doi: 10.1046/j.1523-1755.2002.00641.x.
Cardiac troponin T (cTnT) is related to left ventricular (LV) mass in patients with end-stage renal disease (ESRD). Furthermore, cTnT reflects the severity of systolic dysfunction in patients with heart diseases. We tested the diagnostic value of cTnT for left ventricular hypertrophy (LVH) and LV systolic dysfunction in a large group of clinically stable hemodialysis patients without heart failure.
CTnT was significantly (P < 0.001) higher in patients with LVH than in those with normal LV mass. In a multiple logistic regression model, adjusting for potential confounders (including cardiac ischemia), systolic pressure and cTnT (both P = 0.003) were the strongest correlates of LVH. Similarly, cTnT was significantly higher (P = 0.005) in patients with systolic dysfunction than in those with normal LV function and in a multiple logistic regression model cTnT ranked as the second independent correlate of this alteration after male sex. Serum cTnT had a high positive prediction value for the diagnosis of LVH (87%) but its negative prediction value was relatively low (44%). The positive predictive value of cTnT for LV dysfunction was low (25%) while its negative predictive value was high (93%). A combined analysis including systolic pressure (for the diagnosis of LVH) and sex (for the diagnosis of LV systolic dysfunction) augmented the diagnostic estimates to an important extent (95% positive prediction value for LVH and 98% negative prediction value for LV systolic dysfunction).
CTnT has a fairly good diagnostic potential for the identification of LVH and for the exclusion of LV systolic dysfunction in patients with ESRD without heart failure. This marker may be useful for the screening of alterations in LV mass and function in clinically stable hemodialysis patients.
心脏肌钙蛋白T（cTnT）与终末期肾病（ESRD）患者的左心室（LV）质量相关。此外，cTnT反映了心脏病患者收缩功能障碍的严重程度。我们在一大组无心力衰竭的临床稳定血液透析患者中测试了cTnT对左心室肥厚（LVH）和左心室收缩功能障碍的诊断价值。
LVH患者的cTnT显著高于左心室质量正常的患者（P<0.001）。在多因素逻辑回归模型中，校正潜在混杂因素（包括心肌缺血）后，收缩压和cTnT（均P=0.003）是LVH的最强相关因素。同样，收缩功能障碍患者的cTnT显著高于左心室功能正常的患者（P=0.005），在多因素逻辑回归模型中，cTnT在性别之后是这种改变的第二独立相关因素。血清cTnT对LVH诊断的阳性预测值较高（87%），但其阴性预测值相对较低（44%）。cTnT对左心室功能障碍的阳性预测值较低（25%），而其阴性预测值较高（93%）。包括收缩压（用于LVH诊断）和性别（用于左心室收缩功能障碍诊断）的联合分析在很大程度上提高了诊断估计值（LVH的阳性预测值为95%，左心室收缩功能障碍的阴性预测值为98%）。
cTnT在识别ESRD无心力衰竭患者的LVH和排除左心室收缩功能障碍方面具有相当好的诊断潜力。该标志物可能有助于筛查临床稳定血液透析患者左心室质量和功能的改变。
