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Cardiac troponin T is elevated in asymptomatic patients with chronic renal failure
W L Frankel1, D A Herold, T W Ziegler
1Laboratory Service, VA Medical Center, San Diego, California 92161, USA.
Insights
Elevated cardiac troponin T (cTnT) is common in chronic renal failure (CRF) patients, even without heart attack symptoms. Causes remain unclear, necessitating cautious interpretation of cTnT results in CRF.
Area of Science:
- Nephrology
- Cardiology
- Clinical Chemistry
Background:
- Patients with chronic renal failure (CRF) face heightened risks of myocardial events.
- Evaluating cardiac damage in CRF is challenging due to atypical symptoms and elevated cardiac markers.
- Cardiac troponin T (cTnT) is a sensitive indicator of cardiac injury.
Purpose of the Study:
- To evaluate cardiac troponin T (cTnT) levels in patients with chronic renal failure (CRF) who do not exhibit symptoms of myocardial infarction.
- To investigate potential causes for elevated cTnT in this patient population.
Main Methods:
- Blood samples were collected from patients with CRF undergoing hemodialysis (pre- and post-dialysis), peritoneal dialysis, and those not on dialysis.
- Samples were also obtained from patients with cardiomyopathy and adolescent CRF patients on hemodialysis.
- Analysis included myoglobin, creatine kinase (CK), CK isoenzyme-MB (CK-MB), lactate dehydrogenase (LDH), LDH isoenzyme-1 (LD-1), and cTnT.
Main Results:
- Elevated cTnT was observed in 71% of CRF patients on hemodialysis, 57% on peritoneal dialysis, and 30% not on dialysis.
- Myoglobin was elevated in most CRF patients, while CK-MB and LD-1 were rarely elevated.
- Dialyzable substances and myocardial stretch were not identified as primary causes for elevated cTnT.
Conclusions:
- Elevated cardiac troponin T is prevalent in patients with chronic renal failure, irrespective of dialysis status or symptoms.
- The etiology of elevated cTnT in CRF patients remains to be elucidated.
- Clinical interpretation of cTnT in CRF patients requires caution due to the unclear underlying causes.
Abstract:
Patients with chronic renal failure (CRF) are at increased risk for myocardial events that are difficult to evaluate due to atypical symptoms and chronically elevated protein markers of cardiac damage. This study evaluated cardiac troponin T (cTnT), a sensitive marker of cardiac injury, in patients with CRF without myocardial infarction symptoms, and assessed potential causes for elevated cTnT. Blood was obtained from 38 patients with CRF immediately before hemodialysis and from 16 of them post-dialysis, from 21 peritoneal dialysis patients, 10 patients with CRF not on dialysis, 11 patients with cardiomyopathy, and 10 adolescent patients with CRF undergoing hemodialysis. Samples were analyzed for myoglobin, creatine kinase, creatine kinase isoenzyme-MB (CK-MB), lactate dehydrogenase, lactate dehydrogenase isoenzyme-1 (LD-1), and cTnT. Cardiac TnT was elevated in: 71% of patient with CRF undergoing hemodialysis with no significant differences between pre- and post-dialysis values, 57% of patients with CRF on peritoneal dialysis, 30% of patients with CRF without dialysis, 18% of patients with cardiomyopathy, and 20% of adolescent patients with CRF undergoing hemodialysis. Myoglobin was elevated in almost all patients with CRF undergoing hemodialysis and without dialysis, whereas CK-MB and LD-1 were rarely elevated. Cross-reacting dialyzable substances and myocardial stretch were not major causes for elevated cTnT. Until future studies clarify the etiology of elevated cTnT in patients with CRF, results should be interpreted cautiously.