Nephrology Dialysis Transplantation, Vol 13, Issue 7 1709-1712, Copyright © 1998 by Oxford University Press
G Martin, B Becker and G Schulman
Background: Non-specific elevations of creatine kinase
isoenzymes (CK-MB) and cardiac troponin-T may be seen in renal failure,
confusing the diagnosis of myocardial infarction. Cardiac troponin-I
(cTn-I) has been shown to be specific for myocardial damage in several
disease states, but has not been prospectively evaluated in the setting of
renal failure. Methods: This prospective case series
evaluated 56 patients with acute or chronic renal failure or end-stage
renal disease to assess the sensitivity and specificity of c-Tn-I for
detecting myocardial injury in this patient population. During a 6-month
period, patients admitted with suspected myocardial injury by history,
physical examination, and electrocardiography were evaluated. Cardiac
troponin-I (cTn-I) measurements were assessed between 8 and 48 h after
admission. Appropriate medical care and further cardiac testing
(echocardiography, stress testing, or arteriography) was performed at the
discretion of the primary physician. Results:
Myocardial injury was diagnosed in 18/56 (32%) patients by positive cTn-I
levels, while only 7/56 (13%) patients had evidence of myocardial damage by
CK-MB. Twenty-one of 56 (38%) patients had indeterminate CK-MB levels and
53% of these patients demonstrated myocardial ischaemia on follow-up
testing. Sixteen patients had negative cardiac studies; all of these
patients had negative cTn-I levels, while seven of these 16 (44%) patients
had indeterminate CK-MB measurements. All of the patients with positive
cTn-I levels had positive cardiac studies. Positive troponin levels were
associated with increased in-hospital mortality. Sensitivity and
specificity for CK-MB were 44 and 56% respectively, and 94 and 100% for
cTn-I. Conclusion: These data support the use of cTn-I
for diagnosing mycocardial injury in patients with renal failure. Elevated
cTn-I levels are associated with increased short-term mortality in renal
failure patients. The accuracy of cTn-I could potentially limit unnecessary
cardiac testing in renal failure patients, while the enhanced sensitivity
contributes to risk stratification and aids in diagnosing true myocardial
injury in this population susceptible to non-specific elevations in other
muscle enzymes. Key words: end-stage renal disease;
myocardial ischaemia; renal failure; troponin-I
ORIGINAL ARTICLES
Cardiac troponin-I accurately predicts myocardial injury in renal failure
Department of Internal Medicine, Division of Allergy, Pulmonary, and Critical Care, and Division of Nephrology, Vanderbilt University Medical Center, T-1217 Medical Center North, 1161 21st Avenue South, Nashville, TN 37232-2650, USA; Corresponding author
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  A. Y.-M. Wang and K.-N. Lai Use of Cardiac Biomarkers in End-Stage Renal Disease J. Am. Soc. Nephrol., September 1, 2008; 19(9): 1643 - 1652. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Bozbas, A. Yildirir, and H. Muderrisoglu Cardiac enzymes, renal failure and renal transplantation. Clin. Med. Res., March 1, 2006; 4(1): 79 - 84. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. J. Freda, W. H. W. Tang, F. Van Lente, W. F. Peacock, and G. S. Francis Cardiac troponins in renal insufficiency: Review and clinical implications J. Am. Coll. Cardiol., December 18, 2002; 40(12): 2065 - 2071. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. J. Aviles, A. T. Askari, B. Lindahl, L. Wallentin, G. Jia, E. M. Ohman, K. W. Mahaffey, L. K. Newby, R. M. Califf, M. L. Simoons, et al. Troponin T Levels in Patients with Acute Coronary Syndromes, with or without Renal Dysfunction N. Engl. J. Med., June 27, 2002; 346(26): 2047 - 2052. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. C. Iliou, C. Fumeron, M. O. Benoit, P. Tuppin, C. L. Courvoisier, V. M. Calonge, N. Moatti, C. Buisson, and C. Jacquot Factors associated with increased serum levels of cardiac troponins T and I in chronic haemodialysis patients: Chronic Haemodialysis And New Cardiac Markers Evaluation (CHANCE) study Nephrol. Dial. Transplant., July 1, 2001; 16(7): 1452 - 1458. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Lowbeer, A. Ottosson-Seeberger, S. A. Gustafsson, R. Norrman, J. Hulting, and A. Gutierrez Increased cardiac troponin T and endothelin-1 concentrations in dialysis patients may indicate heart disease Nephrol. Dial. Transplant., August 1, 1999; 14(8): 1948 - 1955. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. C. Stolear, B. Georges, A. Shita, and D. Verbeelen The predictive value of cardiac troponin T measurements in subjects on regular haemodialysis Nephrol. Dial. Transplant., August 1, 1999; 14(8): 1961 - 1967. [Abstract] [Full Text] [PDF]
|
|