Increased cardiac troponin T and endothelin-1 concentrations in dialysis patients may indicate heart disease
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C Löwbeer1, A Ottosson-Seeberger, S A Gustafsson
1Department of Medical Laboratory Sciences and Technology, Huddinge University Hospital, Sweden.
Insights
Elevated cardiac troponin T (cTnT) in dialysis patients may indicate left ventricular hypertrophy or myocardial ischemia, not just heart damage. Endothelin-1 (ET-1) and big endothelin-1 (big ET-1) may be linked to these cardiac conditions in patients undergoing dialysis.
Area of Science:
- Cardiology
- Nephrology
- Biochemistry
Background:
- Cardiac troponin T (cTnT) is a sensitive marker for myocardial damage.
- Dialysis patients often show elevated cTnT without acute myocardial injury, a phenomenon not fully understood.
- Elevated endothelin-1 (ET-1) and big endothelin-1 (big ET-1) have been reported in dialysis patients and may relate to ischemic heart disease.
Purpose of the Study:
- To investigate associations between cTnT, ET-1, big ET-1, other cardiac markers, and cardiac disease in dialysis patients.
- To explore the reasons behind elevated cTnT in patients on chronic dialysis.
- To determine if ET-1 and big ET-1 are linked to cardiac conditions in this population.
Main Methods:
- Studied 36 hemodialysis (HD) and 26 peritoneal dialysis (PD) patients without acute myocardial ischemia symptoms.
- Measured serum cTnT, cardiac troponin I (TnI), CKMB mass, and CK levels.
- Assessed plasma ET-1 and big ET-1 in HD patients, and left ventricular mass index (LVMI) in 27 HD patients.
Main Results:
- Elevated cTnT was observed in 20/36 HD and 8/26 PD patients.
- Patients with ischemic heart disease (IHD) had higher cTnT and ET-1 levels compared to non-IHD patients.
- Positive correlations were found between cTnT and big ET-1, and between cTnT and LVMI in HD patients.
Conclusions:
- Circulating cTnT may indicate left ventricular hypertrophy and/or myocardial ischemia in dialysis patients.
- ET-1 and big ET-1 appear to be associated with cardiac conditions in dialysis patients.
- These findings help clarify the significance of elevated cTnT in chronic dialysis patients.
Background:
Cardiac troponin T (cTnT) is a highly sensitive marker for the detection of myocardial damage. However, patients maintained on chronic dialysis often have increased serum cTnT concentrations without evidence of acute myocardial injury. The reason for this is unclear. In chronic haemodialysis patients, elevated plasma concentrations of big endothelin-1 (big ET-1) and endothelin-1 (ET-1) have been reported which may be associated with ischaemic heart disease. The aim of the present study was to investigate possible associations between cTnT, big ET-1, ET-1, other cardiac markers and cardiac disease in dialysis patients.
Methods:
Thirty-six haemodialysis (HD) patients and 26 peritoneal dialysis (PD) patients without symptoms of acute myocardial ischaemia were investigated. In all patients, serum concentrations of cTnT (2nd generation ELISA), cardiac troponin I (TnI) (Opus, Behring), creatine kinase MB (CKMB) mass and creatine kinase (CK) were determined, in HD patients before and after dialysis. Additionally, in HD patients, plasma ET-1 and big ET-1 were measured. In 27 HD patients, left ventricular mass index (LVMI) was determined. Patients with ischaemic heart disease (IHD) were compared with non-IHD patients.
Results:
Serum cTnT was elevated (> or =0.10 microg/l) in 20 of 36 HD patients and in eight of 26 PD patients. cTnI was elevated (> or =0.5 microg/l) in four of 62 dialysis patients. HD+PD patients with IHD showed higher cTnT than HD+PD patients without IHD, and ET-1 concentrations were higher in HD patients with than without IHD. In HD patients, there was a positive correlation between cTnT and big ET-1. In HD patients with left ventricular hypertrophy (LVH), serum cTnT, CKMB mass and post-dialysis plasma big ET-1 were higher than in patients with normal LVMI. Furthermore there was a positive correlation between cTnT levels and LVMI.
Conclusion:
These findings suggest that circulating cTnT may reflect left ventricular hypertrophy and/or myocardial ischaemia in dialysis patients, and indicate that ET-1 and big ET-1 might be associated with these conditions.
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