Value of troponin T as a screening test of cardiac structure and function in chronic kidney disease

Theodor Bilharz Research Institute

Bibliographic Information

Authors: Nasr F.M.; Metwaly A.; Khalik A.A.; Raafat M.; Nabil M.; Kamel L.; Elsheikh N.

Journal: Global Cardiology Science and Practice

Publisher: HBKU Press

Publication Date: 31 December 2021

Volume / Issue: Volume 2021 / Issue 4

Article No.: 26

ISSN: 23057823

DOI: 10.21542/gcsp.2021.26

Scopus: View on Scopus

Document Type: Article

Access: All Open Access; Gold Open Access; Green Open Access

Authors and Affiliations

Nasr F.M., Intensive Care Department, Theodor Bilharz Research Institute (TBRI), Jizah, Egypt; Metwaly A., Intensive Care Department, Theodor Bilharz Research Institute (TBRI), Jizah, Egypt; Khalik A.A., Intensive Care Department, Theodor Bilharz Research Institute (TBRI), Jizah, Egypt; Raafat M., Nephrology Department, Theodor Bilharz Research Institute, Jizah, Egypt; Nabil M., Nephrology Department, Theodor Bilharz Research Institute, Jizah, Egypt; Kamel L., Clinical Chemistry Department, Theodor Bilharz Research Institute, Jizah, Egypt; Elsheikh N., Nephrology Department, Theodor Bilharz Research Institute, Jizah, Egypt

Abstract

Background: Cardiovascular disease starts early in the course of chronic kidney disease (CKD) and is the leading cause of death in patients with end-stage renal disease. Since high-sensitivity cardiac troponin T (hs-cTnT) can detect much lower levels of myocardial injury than conventional assays, it may be useful for studying the earliest stages of heart disease in patients with CKD. Objective: To evaluate the association of circulating hs-cTnT with LV structural and functional abnormalities detected by echocardiography among dialysis dependent and non-dialysis dependent CKD patients. Methods: This study was conducted on 107 subjects divided into three groups. Group I consisted of CKD patients on conservative treatment (n=42), Group II: hemodialysis patients (n=42), Group III: control group: age and sex matched healthy volunteers (n=23). All subjects were subjected to clinical examination, biochemical evaluation including estimation of hs-cTnT and Echo-Doppler study of cardiac structure and function. Results: There was a significant increase in LAV (p<0.01), LVM (p<0.01) in both patient groups compared to the control group. Mitral annular plane systolic excursion (MAPSE) was significantly decreased in both patient groups compared to the control group (p<0.01, p<0.05) and in group I compared to group II (p<0.05) with a significant decrease in S velocity in group I compared to groups II and III (p<0.01). There was a significant decrease in Vp (p<0.01) with a significant increase in AEF (p<0.01) in both patients’ groups compared to the control group and AEF was significantly increased in group II compared to group I (p<0.01). Ea velocity and Ea/Aa decreased significantly (p<0.01) with significant increase in Aa velocity (p<0.05, p<0.01), E/Ea (p<0.01) and E/Vp (p<0.05) in both patient groups compared to the control group. There was a significant increase in hs-cTnT levels in both patient groups compared to the control group (P<0.01). We found a positive correlation between hs-cTnT levels and LAV (r=0.291, p<0.03), IVST (r=0.374, p<0.004), PWT (r=0.309, p<0.02), LVM (r=0.282, p<0.03), A wave velocity (r=0.271, p<0.04), E/Ea (r=0.506, p<0.0001), PCWP (r=.507, p< 0.0001) and a negative correlation between hs-cTnT and MAPSE (r=-0.300, p<0.02), S wave velocity (r= - 0.259, p<0.05), Ea (r=-626, p<0.0001), Ea/Aa (r=-0.543, p<0.0001). Troponin at the cut-off value of >5 ng/L, revealed 100% sensitivity and 95% specificity with areas under curve (AUC) of 0.998 and accuracy of 95.65% (P<0.01) for discrimination of Group I vs control group and 76.2% sensitivity and 95.7% specificity with AUC 0.796 and accuracy 71.84% (P<0.01) for discrimination of group II vs control group. Conclusion: Structural and functional cardiac abnormalities are common in CKD patients. Serum hs-cTnT levels increased in CKD patients and was associated with LVH, LAV and some of the echocardiographic parameters of LV systolic and diastolic dysfunction. Our research suggests that hs-cTnT levels may be important for early screening of cardiac structure and function in CKD patients to provide evidence for early intervention. © 2021 Bloomsbury Qatar Foundation Journals. All rights reserved.

Keywords

troponin T; A wave; adult; area under the curve; Article; chronic kidney failure; clinical examination; conservative treatment; controlled study; diagnostic test accuracy study; diagnostic value; diastolic dysfunction; echocardiography; female; gene expression; heart disease; heart function; heart left ventricle; hemodialysis; human; human tissue; major clinical study; male; middle aged; mitral annular plane systolic excursion; pulmonary artery occlusion pressure; screening test; sensitivity and specificity; systolic dysfunction

Citation Information

Scopus Citations: 2

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