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Association of cardiac troponin T with left ventricular structure and function in CKD
Rakesh K Mishra1, Yongmei Li, Christopher DeFilippi
1University of California, San Francisco, CA, USA. rakesh.mishra@ucsf.edu
Insights
In patients with chronic kidney disease (CKD), detectable cardiac troponin T (cTnT) strongly indicates left ventricular hypertrophy and modestly predicts systolic dysfunction. This biomarker is not associated with diastolic dysfunction in this population.
Area of Science:
- Cardiology
- Nephrology
- Biomarker Research
Background:
- Serum cardiac troponin T (cTnT) is linked to adverse cardiovascular outcomes.
- Patients with chronic kidney disease (CKD) have an elevated risk of heart failure and cardiovascular death.
- The relationship between cTnT and cardiac abnormalities in CKD patients without heart failure requires further investigation.
Purpose of the Study:
- To evaluate the association between cTnT levels and cardiac structural and functional abnormalities.
- To determine if cTnT can predict left ventricular (LV) hypertrophy, systolic dysfunction, or diastolic dysfunction in CKD patients.
Main Methods:
- A cross-sectional study of 3,243 patients from the Chronic Renal Insufficiency Cohort (CRIC).
- Measured cTnT levels using a highly sensitive assay.
- Utilized echocardiography to assess LV mass, systolic function, and diastolic function, analyzed with logistic and linear regression models.
Main Results:
- Detectable cTnT was present in 84% of participants, with a median level of 13.3 pg/mL.
- The highest quartile of cTnT was associated with a 2.43-fold increased likelihood of LV hypertrophy.
- A modest association was found between cTnT levels and LV systolic dysfunction, but not diastolic dysfunction.
Conclusions:
- Detectable cTnT is strongly associated with pathological LV hypertrophy in CKD patients without heart failure.
- cTnT shows a more modest association with LV systolic dysfunction.
- Circulating cTnT levels in CKD patients primarily serve as an indicator of LV hypertrophy.
Background:
Serum cardiac troponin T (cTnT) is associated with increased risk of heart failure and cardiovascular death in several population settings. We evaluated associations of cTnT levels with cardiac structural and functional abnormalities in a cohort of patients with chronic kidney disease (CKD) without heart failure.
Study Design:
Cross-sectional.
Setting & Participants:
Chronic Renal Insufficiency Cohort (CRIC; N=3,243).
Predictor:
The primary predictor was cTnT level. Secondary predictors included demographic and clinical characteristics, hemoglobin level, high-sensitivity C-reactive protein level, and estimated glomerular filtration rate using cystatin C.
Outcomes:
Echocardiography was used to determine left ventricular (LV) mass and LV systolic and diastolic function.
Measurements:
Circulating cTnT was measured in stored sera using the highly sensitive assay. Logistic and linear regression models were used to examine associations of cTnT level with each echocardiographic outcome.
Results:
cTnT was detectable in 2,735 (84%) persons; median level was 13.3 (IQR, 7.7-23.8) pg/mL. Compared with undetectable cTnT (<3.0 pg/mL), the highest quartile (23.9-738.7 pg/mL) was approximately 2 times as likely to have LV hypertrophy (OR, 2.43; 95% CI, 1.44-4.09) in the fully adjusted model. cTnT level had a more modest association with LV systolic dysfunction; as a log-linear variable, a significant association was present in the fully adjusted model (OR of 1.4 [95% CI, 1.2-1.7] per 1-log unit; P < 0.001). There was no significant independent association between cTnT level and LV diastolic dysfunction. When evaluated as a screening test, cTnT level functioned only modestly for LV hypertrophy and concentric hypertrophy detection (area under the curve, 0.64 for both), with weaker areas under the curve for the other outcomes.
Limitations:
The presence of coronary artery disease was not formally assessed using either noninvasive or angiographic techniques in this study.
Conclusions:
In this large CKD cohort without heart failure, detectable cTnT had a strong association with LV hypertrophy, a more modest association with LV systolic dysfunction, and no association with diastolic dysfunction. These findings indicate that circulating cTnT levels in patients with CKD are predominantly an indicator of pathologic LV hypertrophy.
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