Skip to main content
SpringerLink
Log in

Associations of sensitive cardiac troponin-I with left ventricular morphology, function and prognosis in end-stage renal disease patients with preserved ejection fraction

  • Original Article
  • Published:
Heart and Vessels Aims and scope Submit manuscript

Abstract

Sensitive cardiac troponin I (cTnI) predicts all-cause and cardiovascular mortality in various clinical settings. However, its clinical significance in hemodialysis (HD) patients with preserved left ventricular ejection fraction (LVEF) has not been fully elucidated. This study investigated the association of cTnI with LV morphology and function, and its long-term outcome in HD patients with preserved LVEF. This prospective study consists of 96 HD patients with preserved LVEF (69 ± 8 years and 63% male) who underwent two-dimensional echocardiographic examination and biomarker tests including cTnI, brain natriuretic peptide, and high-sensitive C-reactive protein. The primary endpoint was all-cause death and secondary endpoint was cardiovascular death. Factors independently associated with cTnI were systolic blood pressure (β = − 0.239, p = 0.011), heart rate (β = 0.216, p = 0.021), LV mass index (β = 0.231, p = 0.020), and E to e’ ratio (β = 0.237, p = 0.016). During a mean follow-up of 3.6 years, primary and secondary endpoints were observed in 23 (24%) and 18 (19%) patients, respectively. In the multivariate Cox proportional hazard analysis, the upper cTnI tertile has significantly increased risk of all-cause mortality [hazard ratio (HR), 2.69; 95% confidence interval (CI), 1.139–6.386; p = 0.024] and that of cardiovascular death (HR, 4.56; 95% CI 2.021–16.968; p = 0.006) independent of echocardiographic measures and other serum biomarkers. In HD patients with preserved LVEF, serum cTnI levels were significantly associated with diastolic function and risk of mortality independent of echocardiographic variables and other biomarkers.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Foley RN, Murray AM, Li S, Herzog CA, McBean AM, Eggers PW, Collins AJ (2005) Chronic kidney disease and the risk for cardiovascular disease, renal replacement, and death in the United States medicare population, 1998–1999. J Am Soc Nephrol 16:489–495

    Article  Google Scholar 

  2. Saudan P, Kossovsky M, Halabi G, Martin PY, Perneger TV (2008) Quality of care and survival of haemodialysed patients in western Switzerland. Nephrol Dial Transpl 23:1975–1981

    Article  Google Scholar 

  3. deFilippi C, Wasserman S, Rosanio S, Tiblier E, Sperger H, Tocchi M, Christenson R, Uretsky B, Smiley M, Gold J, Muniz H, Badalamenti J, Herzog C, Henrich W (2003) Cardiac troponin T and C-reactive protein for predicting prognosis, coronary atherosclerosis, and cardiomyopathy in patients undergoing long-term hemodialysis. JAMA 290:353–359

    Article  CAS  Google Scholar 

  4. Sharma R, Gaze DC, Pellerin D, Mehta RL, Gregson H, Streather CP, Collinson PO, Brecker SJD (2006) Cardiac structural and functional abnormalities in end stage renal disease patients with elevated cardiac troponin T. Heart 92:804–809

    Article  CAS  Google Scholar 

  5. Antlanger M, Aschauer S, Kopecky C, Hecking M, Kovarik JJ, Werzowa J, Mascherbauer J, Genser B, Säemann MD, Bonderman D (2017) Heart failure with preserved and reduced ejection fraction in hemodialysis patients: prevalence, disease prediction and prognosis. Kidney Blood Press Res 42:165–176

    Article  Google Scholar 

  6. Liu YW, Su CT, Sung JM, Wang SPH, Su YR, Yang CS, Tsai LM, Chen JH, Tsai WC (2013) Association of left ventricular longitudinal strain with mortality among stable hemodialysis patients with preserved left ventricular ejection fraction. Clin J Am Soc Nephrol 8:1564–1574

    Article  Google Scholar 

  7. Pressman GS, Seetha Rammohan HR, Romero-Corral A, Fumo P, Figueredo VM, Gorcsan J 3rd (2015) Echocardiographic strain and mortality in Black Americans with end-stage renal disease on hemodialysis. Am J Cardiol 116:1601–1604

    Article  Google Scholar 

  8. Khan NA, Hemmelgarn BR, Tonelli M, Thompson CR, Levin A (2005) Prognostic value of troponin T and I among asymptomatic patients with end-stage renal disease: a meta-analysis. Circulation 112:3088–3096

    Article  CAS  Google Scholar 

  9. Artunc F, Mueller C, Breidthardt T, Twerenbold R, Peter A, Thamer C, Weyrich P, Haering HU, Friedrich B (2012) Sensitive troponins—which suits better for hemodialysis patients? Associated factors and prediction of mortality. PLoS One 7:e47610

    Article  CAS  Google Scholar 

  10. Kumar N, Michelis MF, Devita MV, Panagopoulos G, Rosenstock JL (2011) Troponin i levels in asymptomatic patients on haemodialysis using a high-sensitivity assay. Nephrol Dial Transpl 26:665–670

    Article  CAS  Google Scholar 

  11. Artunc F, Nowak A, Müller C, Peter A, Heyne N, Häring HU, Friedrich B (2014) Mortality prediction using modern peptide biomarkers in hemodialysis patients—a comparative analysis. Kidney Blood Press Res 39:563–572

    Article  CAS  Google Scholar 

  12. Buiten MS, De Bie MK, Rotmans JI, Dekker FW, Van Buren M, Rabelink TJ, Cobbaert CM, Schalij MJ, Van Der Laarse A, Jukema JW (2015) Serum cardiac troponin-I is superior to troponin-T as a marker for left ventricular dysfunction in clinically stable patients with end-stage renal disease. PLoS One 10:e0134245

    Article  Google Scholar 

  13. Kruzan RM, Herzog CA, Wu A, Sang Y, Parekh RS, Matsushita K, Hwang S, Cheng A, Coresh J, Powe NR, Shafi T (2016) Association of NTproBNP and cTnI with outpatient sudden cardiac death in hemodialysis patients: the choices for healthy outcomes in caring for ESRD (CHOICE) study. BMC Nephrol 17:18

    Article  Google Scholar 

  14. Michos ED, Wilson LM, Yeh H-C, Berger Z, Suarez-Cuervo C, Stacy SR, Bass EB (2014) Prognostic value of cardiac troponin in patients with chronic kidney disease without suspected acute coronary syndrome: a systematic review. Ann Intern Med 161:491–501

    Article  Google Scholar 

  15. Antman EM, Tanasijevic MJ, Thompson B, Schactman M, McCabe CH, Cannon CP, Fischer GA, Fung AY, Thompson C, Wybenga D, Braunwald E (1996) Cardiac-specific troponin I levels to predict the risk of mortality in patients with acute coronary syndromes. N Engl J Med 335:1342–1349

    Article  CAS  Google Scholar 

  16. Shah ASV, Anand A, Sandoval Y, Lee KK, Smith SW, Adamson PD, Chapman AR, Langdon T, Sandeman D, Vaswani A, Strachan FE, Ferry A, Stirzaker AG, Reid A, Gray AJ, Collinson PO, McAllister DA, Apple FS, Newby DE, Mills NL (2015) High-sensitivity cardiac troponin i at presentation in patients with suspected acute coronary syndrome: a cohort study. Lancet 386:2481–2488

    Article  CAS  Google Scholar 

  17. Blankenberg S, Salomaa V, Makarova N, Ojeda F, Wild P, Lackner KJ, Jørgensen T, Thorand B, Peters A, Nauck M, Petersmann A, Vartiainen E, Veronesi G, Brambilla P, Costanzo S, Iacoviello L, Linden G, Yarnell J, Patterson CC, Everett BM, Ridker PM, Kontto J, Schnabel RB, Koenig W, Kee F, Zeller T, Kuulasmaa K (2016) Troponin i and cardiovascular risk prediction in the general population: the BiomarCaRE consortium. Eur Heart J 37:2428–2437

    Article  CAS  Google Scholar 

  18. Everett BM, Zeller T, Glynn RJ, Ridker PM, Blankenberg S (2015) High-sensitivity cardiac troponin I and B-type natriuretic peptide as predictors of vascular events in primary prevention impact of statin therapy. Circulation 131:1851–1860

    Article  CAS  Google Scholar 

  19. Ford I, Shah ASV, Zhang R, McAllister DA, Strachan FE, Caslake M, Newby DE, Packard CJ, Mills NL (2016) High-sensitivity cardiac troponin, statin therapy, and risk of coronary heart disease. J Am Coll Cardiol 68:2719–2728

    Article  CAS  Google Scholar 

  20. Mallamaci F, Zoccali C, Parlongo S, Tripepi G, Benedetto FA, Cutrupi S, Bonanno G, Fatuzzo P, Rapisarda F, Seminara G, Stancanelli B, Bellanuova I, Cataliotti A, Malatino LS (2002) Diagnostic value of troponin T for alterations in left ventricular mass and function in dialysis patients. Kidney Int 62:1884–1890

    Article  Google Scholar 

  21. Brunet P, Oddoze C, Paganelli F, Indreies M, Faure V, Opris-Saveanu A, Morange S, Portugal H, Dussol B, Berland Y (2008) Cardiac troponins I and T in hemodialysis patients without acute coronary syndrome. Int J Cardiol 129:205–209

    Article  Google Scholar 

  22. Silberberg JS, Barre PE, Prichard SS, Sniderman AD (1989) Impact of left ventricular hypertrophy on survival in end-stage renal disease. Kidney Int 36:286–290

    Article  CAS  Google Scholar 

  23. K/DOQI Workgroup (2005) K/DOQI clinical practice guidelines for cardiovascular disease in dialysis patients. Am J Kidney Dis 45(4 Suppl 3):S1–S153

    Google Scholar 

  24. Devereux RB, Reichek N (1977) Echocardiographic determination of left ventricular mass in man. Anatomic validation of the method. Circulation 55:613–618

    Article  CAS  Google Scholar 

  25. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise JS, Solomon SD, Spencer KT, Sutton MSJ, Stewart WJ (2005) Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiograph. J Am Soc Echocardiogr 18:1440–1463

    Article  Google Scholar 

  26. Seliger SL, Hong SN, Christenson RH, Kronmal R, Daniels LB, Lima JA, de Lemos JA, Bertoni AG, deFilippi CR (2017) High sensitive cardiac troponin T as an early biochemical signature for clinical and subclinical heart failure: the multi-ethnic study of atherosclerosis. Circulation. https://doi.org/10.1161/CIRCULATIONAHA.116.025505

    Article  PubMed  PubMed Central  Google Scholar 

  27. Narolska NA, Piroddi N, Belus A, Boontje NM, Scellini B, Deppermann S, Zaremba R, Musters RJ, Dos Remedios C, Jaquet K, Foster DB, Murphy AM, Van Eyk JE, Tesi C, Poggesi C, Van Der Velden J, Stienen GJM (2006) Impaired diastolic function after exchange of endogenous troponin I with C-terminal truncated troponin I in human cardiac muscle. Circ Res 99:1012–1020

    Article  CAS  Google Scholar 

  28. Singh N, Langer A, Freeman MR, Goldstein MB (1994) Myocardial alterations during hemodialysis: insights from new noninvasive technology. Am J Nephrol 14:173–181

    Article  CAS  Google Scholar 

  29. Niizuma S, Takiuchi S, Okada S, Horio T, Kamide K, Nakata H, Yoshihara F, Nakamura S, Kawano Y, Nakahama H, Iwanaga Y, Nakatani S (2008) Decreased coronary flow reserve in haemodialysis patients. Nephrol Dial Transpl 23:2324–2328

    Article  Google Scholar 

  30. Takashio S, Yamamuro M, Izumiya Y, Sugiyama S, Kojima S, Yamamoto E, Tsujita K, Tanaka T, Tayama S, Kaikita K, Hokimoto S, Ogawa H (2013) Coronary microvascular dysfunction and diastolic load correlate with cardiac troponin T release measured by a highly sensitive assay in patients with nonischemic heart failure. J Am Coll Cardiol 62:632–640

    Article  CAS  Google Scholar 

  31. Odar-Cederlof I, Bjellerup P, Williams A, Blagg CR, Twardowski Z, Ting G, Kjellstrand CM (2006) Daily dialyses decrease plasma levels of brain natriuretic peptide (BNP), a biomarker of left ventricular dysfunction. Hemodial Int 10:394–398

    Article  Google Scholar 

  32. Arici M, Walls J (2001) End-stage renal disease, atherosclerosis, and cardiovascular mortality: is C-reactive protein the missing link? Kidney Int 59:407–414

    Article  CAS  Google Scholar 

  33. Okuyama R, Ishii J, Takahashi H, Kawai H, Muramatsu T, Harada M, Yamada A, Motoyama S, Matsui S, Naruse H, Sarai M, Hasegawa M, Watanabe E, Suzuki A, Hayashi M, Izawa H, Yuzawa Y, Ozaki Y (2017) Combination of high-sensitivity troponin I and N-terminal pro-B-type natriuretic peptide predicts future hospital admission for heart failure in high-risk hypertensive patients with preserved left ventricular ejection fraction. Heart Vessels 32:880–892

    Article  Google Scholar 

  34. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, Van Der Meer P (2016) 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 37:2129–2200

    Article  Google Scholar 

  35. Roffi M, Patrono C, Collet J-P, Mueller C, Valgimigli M, Andreotti F, Bax JJ, Borger MA, Brotons C, Chew DP, Gencer B, Hasenfuss G, Kjeldsen K, Lancellotti P, Landmesser U, Mehilli J, Mukherjee D, Storey RF, Windecker S (2016) 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J 37:267–315

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Cardiovascular Medicine, Ishikiri-seiki Hospital, Higashi-osaka, 18-28 Yayoi, Higashi-osaka, 550-0022, Japan

    Kenichiro Otsuka, Haruo Nakamura, Hitoshi Inanami, Hiroki Nishioka, Kohei Fujimoto & Noriaki Kasayuki

  2. Department of Cardiovascular Medicine, Baba Memorial Hospital, Sakai, Japan

    Koki Nakanishi

  3. Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan

    Kenei Shimada & Minoru Yoshiyama

Authors
  1. Kenichiro Otsuka
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Koki Nakanishi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kenei Shimada
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Haruo Nakamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hitoshi Inanami
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hiroki Nishioka
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kohei Fujimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Noriaki Kasayuki
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Minoru Yoshiyama
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kenichiro Otsuka.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Otsuka, K., Nakanishi, K., Shimada, K. et al. Associations of sensitive cardiac troponin-I with left ventricular morphology, function and prognosis in end-stage renal disease patients with preserved ejection fraction. Heart Vessels 33, 1334–1342 (2018). https://doi.org/10.1007/s00380-018-1192-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00380-018-1192-7

Keywords

Search

Navigation