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Cardiac structural and functional abnormalities in end stage renal disease patients with elevated cardiac troponin T
  1. R Sharma1,
  2. D C Gaze2,
  3. D Pellerin3,
  4. R L Mehta4,
  5. H Gregson5,
  6. C P Streather5,
  7. P O Collinson2,
  8. S J D Brecker1
  1. 1Department of Cardiology, St George’s Hospital, London, UK
  2. 2Department of Chemical Pathology, St George’s Hospital, London, UK
  3. 3The Heart Hospital, London, UK
  4. 4Department of Medical Statistics, Southampton General Hospital, Southampton, UK
  5. 5Department of Renal Medicine, St George’s Hospital, London, UK
  1. Correspondence to:
    Dr Rajan Sharma
    Wessex Cardiothoracic Unit, Southampton General Hospital, Southampton SO16 6YD, UK; rajdoc.Sharma{at}tiscali.co.uk

Abstract

Objectives: To identify in a prospective observational study the cardiac structural and functional abnormalities and mortality in patients with end stage renal disease (ESRD) with a raised cardiac troponin T (cTnT) concentration.

Methods: 126 renal transplant candidates were studied over a two year period. Clinical, biochemical, echocardiographic, coronary angiographic, and dobutamine stress echocardiographic (DSE) data were examined in comparison with cTnT concentrations dichotomised at cut off concentrations of < 0.04 μg/l and < 0.10 μg/l.

Results: Left ventricular (LV) size and filling pressure were significantly raised and LV systolic and diastolic function parameters significantly impaired in patients with raised cTnT, irrespective of the cut off concentration. The proportions of patients with diabetes and on dialysis were higher in both groups with raised cTnT. With a cut off cTnT concentration of 0.04 μg/l but not 0.10 μg/l, significantly more patients had severe coronary artery disease and a positive DSE result. The total ischaemic burden during DSE was similar in cTnT positive and negative patients, irrespective of the cut off concentration used. LV end systolic diameter index and E:Ea ratio were independent predictors of cTnT rises ⩾ 0.04 μg/l and ⩾ 0.10 μg/l, respectively. Diabetes was independently associated with cTnT at both cut off concentrations. Mortality was higher in all patients with raised cTnT.

Conclusions: Patients with ESRD with raised cTnT concentrations have increased mortality. Raised concentrations are strongly associated with diabetes, LV dilatation, and impaired LV systolic and diastolic function, but not with severe coronary artery disease.

  • BNP, brain natriuretic peptide
  • CAD, coronary artery disease
  • cTnT, cardiac troponin T
  • DSE, dobutamine stress echocardiography
  • ESRD, end stage renal disease
  • LV, left ventricular
  • LVEF, left ventricular ejection fraction
  • LVMI, left ventricular mass index
  • NT-proBNP, N-terminal pro-B-type natriuretic peptide
  • Vp, propagation velocity
  • end stage renal disease
  • cardiac troponin T
  • renal failure
  • cardiac structure

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Footnotes

  • Published Online First 10 October 2005

  • Competing interests: None of the authors have any conflict of interest associated with this manuscript.

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