Risk stratification using serum concentrations of cardiac troponin T in patients with end-stage renal disease on chronic maintenance dialysis

Junichi Ishii, Masanori Nomura, Toshio Okuma, Taro Minagawa, Hiroyuki Naruse, Yoshihisa Mori, Takashi Ishikawa, Hiroshi Kurokawa, Takahiro Hirano, Takeshi Kondo, Youichi Nagamura, Kouji Ezaki, Hitoshi Hishida

Research output: Contribution to journalArticle

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Abstract

Background: It has been recently suggested that cardiac troponin T (cTnT) may be more sensitive than troponin I (cTnI) for subclinical myocardial cell injury in patients on chronic dialysis. Methods: We prospectively compared the predictive value of cTnT with cTnI, atrial (ANP) and brain natriuretic peptide (BNP) in 100 consecutive outpatients on chronic dialysis without acute coronary syndromes over a period of 3 months, and assessed whether the combination of cTnT with clinical information including age, duration of dialysis, and medical histories was useful for risk stratification of these patients. During the 2-year follow-up period, 19 patients died, mostly due to cardiac causes (53%). Results: The area under the receiver operator characteristic (ROC) curve for the cTnT as predictor of both overall and cardiac death was significantly greater than the area under the cTnI curve (p<0.0001 and p=0.01), the BNP curve (p<0.001 and p<0.01) or the ANP curve (p<0.0001 and p<0.005). In a stepwise multivariate Cox regression analysis, only cTnT (p<0.05 and p<0.01) and a history of heart failure requiring hospitalization (p<0.05 and p<0.005) were independent predictors of both all cause and cardiac mortality. Using parameters of cTnT ≥0.1 μg/l and/or history of heart failure, the overall and cardiac mortality rate for the low risk group (n=66) were 4.5% and 1.5%, respectively, 40% and 16% for the intermediate risk group (n=25), and 67% and 56% for the high risk group (n=9). Conclusion: cTnT concentrations offer a higher prognostic accuracy than cTnI, ANP and BNP in patients on chronic dialysis. The combination of elevated cTnT and a history of heart failure may be a highly effective means of risk stratification of these patients.

Original languageEnglish
Pages (from-to)69-79
Number of pages11
JournalClinica Chimica Acta
Volume312
Issue number1-2
DOIs
Publication statusPublished - 10-10-2001

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Troponin T
Dialysis
Chronic Kidney Failure
Maintenance
Atrial Natriuretic Factor
Serum
Brain Natriuretic Peptide
Heart Failure
Troponin I
Mortality
Acute Coronary Syndrome
Regression analysis
Area Under Curve
Hospitalization
Outpatients
Regression Analysis
Wounds and Injuries

All Science Journal Classification (ASJC) codes

  • Biochemistry
  • Clinical Biochemistry
  • Biochemistry, medical

Cite this

Ishii, Junichi ; Nomura, Masanori ; Okuma, Toshio ; Minagawa, Taro ; Naruse, Hiroyuki ; Mori, Yoshihisa ; Ishikawa, Takashi ; Kurokawa, Hiroshi ; Hirano, Takahiro ; Kondo, Takeshi ; Nagamura, Youichi ; Ezaki, Kouji ; Hishida, Hitoshi. / Risk stratification using serum concentrations of cardiac troponin T in patients with end-stage renal disease on chronic maintenance dialysis. In: Clinica Chimica Acta. 2001 ; Vol. 312, No. 1-2. pp. 69-79.
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title = "Risk stratification using serum concentrations of cardiac troponin T in patients with end-stage renal disease on chronic maintenance dialysis",
abstract = "Background: It has been recently suggested that cardiac troponin T (cTnT) may be more sensitive than troponin I (cTnI) for subclinical myocardial cell injury in patients on chronic dialysis. Methods: We prospectively compared the predictive value of cTnT with cTnI, atrial (ANP) and brain natriuretic peptide (BNP) in 100 consecutive outpatients on chronic dialysis without acute coronary syndromes over a period of 3 months, and assessed whether the combination of cTnT with clinical information including age, duration of dialysis, and medical histories was useful for risk stratification of these patients. During the 2-year follow-up period, 19 patients died, mostly due to cardiac causes (53{\%}). Results: The area under the receiver operator characteristic (ROC) curve for the cTnT as predictor of both overall and cardiac death was significantly greater than the area under the cTnI curve (p<0.0001 and p=0.01), the BNP curve (p<0.001 and p<0.01) or the ANP curve (p<0.0001 and p<0.005). In a stepwise multivariate Cox regression analysis, only cTnT (p<0.05 and p<0.01) and a history of heart failure requiring hospitalization (p<0.05 and p<0.005) were independent predictors of both all cause and cardiac mortality. Using parameters of cTnT ≥0.1 μg/l and/or history of heart failure, the overall and cardiac mortality rate for the low risk group (n=66) were 4.5{\%} and 1.5{\%}, respectively, 40{\%} and 16{\%} for the intermediate risk group (n=25), and 67{\%} and 56{\%} for the high risk group (n=9). Conclusion: cTnT concentrations offer a higher prognostic accuracy than cTnI, ANP and BNP in patients on chronic dialysis. The combination of elevated cTnT and a history of heart failure may be a highly effective means of risk stratification of these patients.",
author = "Junichi Ishii and Masanori Nomura and Toshio Okuma and Taro Minagawa and Hiroyuki Naruse and Yoshihisa Mori and Takashi Ishikawa and Hiroshi Kurokawa and Takahiro Hirano and Takeshi Kondo and Youichi Nagamura and Kouji Ezaki and Hitoshi Hishida",
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Ishii, J, Nomura, M, Okuma, T, Minagawa, T, Naruse, H, Mori, Y, Ishikawa, T, Kurokawa, H, Hirano, T, Kondo, T, Nagamura, Y, Ezaki, K & Hishida, H 2001, 'Risk stratification using serum concentrations of cardiac troponin T in patients with end-stage renal disease on chronic maintenance dialysis', Clinica Chimica Acta, vol. 312, no. 1-2, pp. 69-79. https://doi.org/10.1016/S0009-8981(01)00592-7

Risk stratification using serum concentrations of cardiac troponin T in patients with end-stage renal disease on chronic maintenance dialysis. / Ishii, Junichi; Nomura, Masanori; Okuma, Toshio; Minagawa, Taro; Naruse, Hiroyuki; Mori, Yoshihisa; Ishikawa, Takashi; Kurokawa, Hiroshi; Hirano, Takahiro; Kondo, Takeshi; Nagamura, Youichi; Ezaki, Kouji; Hishida, Hitoshi.

In: Clinica Chimica Acta, Vol. 312, No. 1-2, 10.10.2001, p. 69-79.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Risk stratification using serum concentrations of cardiac troponin T in patients with end-stage renal disease on chronic maintenance dialysis

AU - Ishii, Junichi

AU - Nomura, Masanori

AU - Okuma, Toshio

AU - Minagawa, Taro

AU - Naruse, Hiroyuki

AU - Mori, Yoshihisa

AU - Ishikawa, Takashi

AU - Kurokawa, Hiroshi

AU - Hirano, Takahiro

AU - Kondo, Takeshi

AU - Nagamura, Youichi

AU - Ezaki, Kouji

AU - Hishida, Hitoshi

PY - 2001/10/10

Y1 - 2001/10/10

N2 - Background: It has been recently suggested that cardiac troponin T (cTnT) may be more sensitive than troponin I (cTnI) for subclinical myocardial cell injury in patients on chronic dialysis. Methods: We prospectively compared the predictive value of cTnT with cTnI, atrial (ANP) and brain natriuretic peptide (BNP) in 100 consecutive outpatients on chronic dialysis without acute coronary syndromes over a period of 3 months, and assessed whether the combination of cTnT with clinical information including age, duration of dialysis, and medical histories was useful for risk stratification of these patients. During the 2-year follow-up period, 19 patients died, mostly due to cardiac causes (53%). Results: The area under the receiver operator characteristic (ROC) curve for the cTnT as predictor of both overall and cardiac death was significantly greater than the area under the cTnI curve (p<0.0001 and p=0.01), the BNP curve (p<0.001 and p<0.01) or the ANP curve (p<0.0001 and p<0.005). In a stepwise multivariate Cox regression analysis, only cTnT (p<0.05 and p<0.01) and a history of heart failure requiring hospitalization (p<0.05 and p<0.005) were independent predictors of both all cause and cardiac mortality. Using parameters of cTnT ≥0.1 μg/l and/or history of heart failure, the overall and cardiac mortality rate for the low risk group (n=66) were 4.5% and 1.5%, respectively, 40% and 16% for the intermediate risk group (n=25), and 67% and 56% for the high risk group (n=9). Conclusion: cTnT concentrations offer a higher prognostic accuracy than cTnI, ANP and BNP in patients on chronic dialysis. The combination of elevated cTnT and a history of heart failure may be a highly effective means of risk stratification of these patients.

AB - Background: It has been recently suggested that cardiac troponin T (cTnT) may be more sensitive than troponin I (cTnI) for subclinical myocardial cell injury in patients on chronic dialysis. Methods: We prospectively compared the predictive value of cTnT with cTnI, atrial (ANP) and brain natriuretic peptide (BNP) in 100 consecutive outpatients on chronic dialysis without acute coronary syndromes over a period of 3 months, and assessed whether the combination of cTnT with clinical information including age, duration of dialysis, and medical histories was useful for risk stratification of these patients. During the 2-year follow-up period, 19 patients died, mostly due to cardiac causes (53%). Results: The area under the receiver operator characteristic (ROC) curve for the cTnT as predictor of both overall and cardiac death was significantly greater than the area under the cTnI curve (p<0.0001 and p=0.01), the BNP curve (p<0.001 and p<0.01) or the ANP curve (p<0.0001 and p<0.005). In a stepwise multivariate Cox regression analysis, only cTnT (p<0.05 and p<0.01) and a history of heart failure requiring hospitalization (p<0.05 and p<0.005) were independent predictors of both all cause and cardiac mortality. Using parameters of cTnT ≥0.1 μg/l and/or history of heart failure, the overall and cardiac mortality rate for the low risk group (n=66) were 4.5% and 1.5%, respectively, 40% and 16% for the intermediate risk group (n=25), and 67% and 56% for the high risk group (n=9). Conclusion: cTnT concentrations offer a higher prognostic accuracy than cTnI, ANP and BNP in patients on chronic dialysis. The combination of elevated cTnT and a history of heart failure may be a highly effective means of risk stratification of these patients.

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