Abstract
Objective
To identify the relationship between serum high-sensitive cardiac troponin T (hs-cTnT) and left ventricular diastolic dysfunction (LVDD) among maintenance hemodialysis patients and to further explore the value of hs-cTnT in evaluating and predicting LVDD in this special group of patients.
Methods
In a cross-sectional study, 152 dialysis patients with end-stage renal disease (ESRD) underwent Hs-cTnT measurement using the high sensitivity assay. Echocardiography measurements were carried out according to the American Society of Echocardiography recommendations and E/E′ > 15 or E′ < 7 cm/s was defined as diastolic dysfunction. Demographic, biochemical, and echocardiographic values of left ventricular mass index (LVMI), left ventricular ejection fraction (LVEF), left atrial diameter, early/late peak velocities ratio (E/A), early peak diastolic annular velocity (E′) and E/E′ were compared across quartiles of hs-cTnT. The association of plasma hs-cTnT concentrations with echocardiographic parameters was analyzed by Spearman’s correlation. The relationship between serum hs-cTnT and LVDD parameters of E/E′ and E′ was analyzed using multivariate regression analysis, and the value of hs-cTnT on assessing LVDD was evaluated by receiver-operating characteristic (ROC) curves.
Results
The median value of hs-cTnT was 45 pg/ml (range 28–73). All patients had detectable hs-cTnT, while 88% had greater hs-cTnT than the 99th percentile of the general population (14 pg/ml). Serum hs-cTnT values showed a significantly positive correlation with E/E′ (r = 0.739, p < 0.001) and LVMI (r = 0.608, p < 0.001), but showed a negative correlation with E′ (r = − 0.554, p < 0.001). Serum hs-cTnT was not associated with LV systolic dysfunction. The associations of hs-cTnT with E/E′ and E′ persisted after multivariate adjustment for LVMI and comorbidities. In logistic multiple regression analysis, compared with the lowest quartile of hs-cTnT, the highest two quartiles were approximately 5 and 11 times more likely to have E/E′ > 15 and 7 and 17 times more likely to have E′ < 7 cm/s. The area under the ROC curve for hs-cTnT evaluating E/E′ > 15 was 0.847 and evaluating E′ < 7 cm/s was 0.799, which denoted a moderate accuracy.
Conclusions
Our studies suggest that serum hs-cTnT may serve as a biomarker of LVDD in hemodialysis patients.
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Funding
This work was supported by Shanghai Health and Family Planning Commission Foundation of Changning District (20174Y004), and National Science Foundation of China (81770718).
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All procedures performed in this study were in accordance with the ethical standards of the institutional and international research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Sun, L., Ji, Y., Wang, Y. et al. High-sensitive cardiac troponin T: a biomarker of left-ventricular diastolic dysfunction in hemodialysis patients. J Nephrol 31, 967–973 (2018). https://doi.org/10.1007/s40620-018-0540-0
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DOI: https://doi.org/10.1007/s40620-018-0540-0