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High-Sensitivity Cardiac Troponin Concentrations in Patients with Chest Discomfort: Is It the Heart or the Kidneys As Well?

BACKGROUND: High-sensitivity cardiac troponins (hs-cTn) are the preferred biomarkers to detect myocardial injury, making them promising risk-stratifying tools for patients with symptoms of chest pain. However, circulating hs-cTn are also elevated in other conditions like renal dysfunction, complicat...

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Autores principales: Cardinaels, Eline P. M., Altintas, Sibel, Versteylen, Mathijs O., Joosen, Ivo A., Jellema, Laurens-Jan C., Wildberger, Joachim E., Das, Marco, Crijns, Harry J., Bekers, Otto, van Dieijen-Visser, Marja P., Kietselaer, Bastiaan L., Mingels, Alma M. A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4838230/
https://www.ncbi.nlm.nih.gov/pubmed/27096420
http://dx.doi.org/10.1371/journal.pone.0153300
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author Cardinaels, Eline P. M.
Altintas, Sibel
Versteylen, Mathijs O.
Joosen, Ivo A.
Jellema, Laurens-Jan C.
Wildberger, Joachim E.
Das, Marco
Crijns, Harry J.
Bekers, Otto
van Dieijen-Visser, Marja P.
Kietselaer, Bastiaan L.
Mingels, Alma M. A.
author_facet Cardinaels, Eline P. M.
Altintas, Sibel
Versteylen, Mathijs O.
Joosen, Ivo A.
Jellema, Laurens-Jan C.
Wildberger, Joachim E.
Das, Marco
Crijns, Harry J.
Bekers, Otto
van Dieijen-Visser, Marja P.
Kietselaer, Bastiaan L.
Mingels, Alma M. A.
author_sort Cardinaels, Eline P. M.
collection PubMed
description BACKGROUND: High-sensitivity cardiac troponins (hs-cTn) are the preferred biomarkers to detect myocardial injury, making them promising risk-stratifying tools for patients with symptoms of chest pain. However, circulating hs-cTn are also elevated in other conditions like renal dysfunction, complicating appropriate interpretation of low-level hs-cTn concentrations. METHODS: A cross-sectional analysis was performed in 1864 patients with symptoms of chest discomfort from the cardiology outpatient department who underwent cardiac computed tomographic angiography (CCTA). Serum samples were analyzed using hs-cTnT and hs-cTnI assays. Renal function was measured by the estimated glomerular filtration rate (eGFR), established from serum creatinine and cystatin C. On follow-up, the incidence of adverse events was assessed. RESULTS: Median hs-cTnT and hs-cTnI concentrations were 7.2(5.8–9.2) ng/L and 2.6(1.8–4.1) ng/L, respectively. Multivariable regression analysis revealed that both assay results were more strongly associated with eGFR (hs-cTnT:stβ:-0.290;hs-cTnI:stβ:-0.222) than with cardiac imaging parameters, such as coronary calcium score, CCTA plaque severity score and left ventricular mass (all p<0.01). Furthermore, survival analysis indicated lower relative risks in patients with normal compared to reduced renal function for hs-cTnT [HR(95%CI), 1.02(1.00–1.03) compared to 1.07(1.05–1.09)] and hs-cTnI [1.01(1.00–1.01) compared to 1.02(1.01–1.02)] (all p<0.001). CONCLUSION: In patients with chest discomfort, we identified an independent influence of renal function on hs-cTn concentrations besides CAD, that affected the association of hs-cTn concentrations with adverse events. Estimating renal function is therefore warranted when interpreting baseline hs-cTn concentrations.
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spelling pubmed-48382302016-04-29 High-Sensitivity Cardiac Troponin Concentrations in Patients with Chest Discomfort: Is It the Heart or the Kidneys As Well? Cardinaels, Eline P. M. Altintas, Sibel Versteylen, Mathijs O. Joosen, Ivo A. Jellema, Laurens-Jan C. Wildberger, Joachim E. Das, Marco Crijns, Harry J. Bekers, Otto van Dieijen-Visser, Marja P. Kietselaer, Bastiaan L. Mingels, Alma M. A. PLoS One Research Article BACKGROUND: High-sensitivity cardiac troponins (hs-cTn) are the preferred biomarkers to detect myocardial injury, making them promising risk-stratifying tools for patients with symptoms of chest pain. However, circulating hs-cTn are also elevated in other conditions like renal dysfunction, complicating appropriate interpretation of low-level hs-cTn concentrations. METHODS: A cross-sectional analysis was performed in 1864 patients with symptoms of chest discomfort from the cardiology outpatient department who underwent cardiac computed tomographic angiography (CCTA). Serum samples were analyzed using hs-cTnT and hs-cTnI assays. Renal function was measured by the estimated glomerular filtration rate (eGFR), established from serum creatinine and cystatin C. On follow-up, the incidence of adverse events was assessed. RESULTS: Median hs-cTnT and hs-cTnI concentrations were 7.2(5.8–9.2) ng/L and 2.6(1.8–4.1) ng/L, respectively. Multivariable regression analysis revealed that both assay results were more strongly associated with eGFR (hs-cTnT:stβ:-0.290;hs-cTnI:stβ:-0.222) than with cardiac imaging parameters, such as coronary calcium score, CCTA plaque severity score and left ventricular mass (all p<0.01). Furthermore, survival analysis indicated lower relative risks in patients with normal compared to reduced renal function for hs-cTnT [HR(95%CI), 1.02(1.00–1.03) compared to 1.07(1.05–1.09)] and hs-cTnI [1.01(1.00–1.01) compared to 1.02(1.01–1.02)] (all p<0.001). CONCLUSION: In patients with chest discomfort, we identified an independent influence of renal function on hs-cTn concentrations besides CAD, that affected the association of hs-cTn concentrations with adverse events. Estimating renal function is therefore warranted when interpreting baseline hs-cTn concentrations. Public Library of Science 2016-04-20 /pmc/articles/PMC4838230/ /pubmed/27096420 http://dx.doi.org/10.1371/journal.pone.0153300 Text en © 2016 Cardinaels et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Cardinaels, Eline P. M.
Altintas, Sibel
Versteylen, Mathijs O.
Joosen, Ivo A.
Jellema, Laurens-Jan C.
Wildberger, Joachim E.
Das, Marco
Crijns, Harry J.
Bekers, Otto
van Dieijen-Visser, Marja P.
Kietselaer, Bastiaan L.
Mingels, Alma M. A.
High-Sensitivity Cardiac Troponin Concentrations in Patients with Chest Discomfort: Is It the Heart or the Kidneys As Well?
title High-Sensitivity Cardiac Troponin Concentrations in Patients with Chest Discomfort: Is It the Heart or the Kidneys As Well?
title_full High-Sensitivity Cardiac Troponin Concentrations in Patients with Chest Discomfort: Is It the Heart or the Kidneys As Well?
title_fullStr High-Sensitivity Cardiac Troponin Concentrations in Patients with Chest Discomfort: Is It the Heart or the Kidneys As Well?
title_full_unstemmed High-Sensitivity Cardiac Troponin Concentrations in Patients with Chest Discomfort: Is It the Heart or the Kidneys As Well?
title_short High-Sensitivity Cardiac Troponin Concentrations in Patients with Chest Discomfort: Is It the Heart or the Kidneys As Well?
title_sort high-sensitivity cardiac troponin concentrations in patients with chest discomfort: is it the heart or the kidneys as well?
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4838230/
https://www.ncbi.nlm.nih.gov/pubmed/27096420
http://dx.doi.org/10.1371/journal.pone.0153300
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