Department of Cardiology, Nihon University Hospital, Tokyo, Japan,
Division of Cardiology, Kindai University Faculty of Medicine, Osakasayama, Japan.
Kidney Blood Press Res. 2019;44(5):1050-1062. doi: 10.1159/000502232. Epub 2019 Sep 5.
An increased cardiac troponin T (cTnT) level identifies a high-risk group in patients with end-stage renal disease; however, the mechanism of cTnT elevation remains unclear in such patients without acute coronary syndrome (ACS). Therefore, we explored the relationship between cTnT levels and the hemodynamic parameters and the prognostic potential of cTnT in stable patients with chronic hemodialysis (HD).
We included consecutive 174 patients with HD who were referred for coronary angiography due to stable coronary artery disease (CAD), peripheral artery disease (PAD), or heart failure (HF). Hemodynamic measurement was performed, and plasma cTnT, B-type natriuretic peptide (BNP), and A-type natriuretic peptide (ANP) were measured at the same time. The potential of 3 biomarkers to predict all-cause mortality, cardiac death or hospitalized HF, and vascular event was assessed.
Increased log cTnT levels were correlated with increased log BNP and log ANP levels (r = 0.531, p < 0.001 and r = 0.411, p < 0.001, respectively). Not increased log cTnT, but increased log BNP and log ANP were associated with the presence of CAD and the extent of CAD. In contrast, they were all associated with the New York Heart Association functional classification and the presence of PAD and significantly correlated with left ventricular end-diastolic pressure (LVEDP) in an independent manner. Increased cTnT and BNP levels were associated with the mortality and hospitalized HF. However, increased cTnT was not associated with vascular events, unlike increased BNP.
In patients with chronic HD without ACS, increased cTnT reflected increased LVEDP and the presence of HF or PAD independently, and it did not reflect the presence of CAD in contrast to increased BNP. cTnT and BNP were significant prognostic predictors; however, increased cTnT was associated with HF-related events, not with arteriosclerotic events.
心脏肌钙蛋白 T（cTnT）水平升高可识别出终末期肾病患者中的高危人群；然而，在无急性冠状动脉综合征（ACS）的此类患者中，cTnT 升高的机制尚不清楚。因此，我们探讨了稳定期慢性血液透析（HD）患者 cTnT 水平与血流动力学参数之间的关系，以及 cTnT 的预后价值。
我们纳入了 174 例因稳定型冠状动脉疾病（CAD）、外周动脉疾病（PAD）或心力衰竭（HF）而行冠状动脉造影检查的 HD 患者。同时检测血流动力学参数和血浆 cTnT、B 型利钠肽（BNP）和氨基末端 B 型利钠肽前体（ANP）水平。评估 3 种生物标志物预测全因死亡率、心脏性死亡或住院 HF 以及血管事件的潜在价值。
升高的 log cTnT 水平与升高的 log BNP 和 log ANP 水平相关（r = 0.531，p < 0.001 和 r = 0.411，p < 0.001）。不是升高的 log cTnT，而是升高的 log BNP 和 log ANP 与 CAD 的存在和 CAD 的严重程度相关。相比之下，它们均与纽约心脏协会功能分类以及 PAD 的存在相关，并与左心室舒张末期压（LVEDP）独立相关。升高的 cTnT 和 BNP 水平与死亡率和住院 HF 相关。然而，与升高的 BNP 不同，升高的 cTnT 与血管事件无关。
在无 ACS 的慢性 HD 患者中，升高的 cTnT 独立地反映了 LVEDP 升高和 HF 或 PAD 的存在，与升高的 BNP 不同，它不反映 CAD 的存在。cTnT 和 BNP 是重要的预后预测指标；然而，升高的 cTnT 与 HF 相关事件相关，而与动脉粥样硬化性事件无关。
