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Variation in and prognostic importance of troponin T measured using a high-sensitivity assay in clinically stable haemodialysis patients

BACKGROUND: A recently introduced high-sensitivity assay can measure troponin T (hsT) at low levels with greater precision than the fourth generation troponin T assay. As most patients with end-stage renal failure (ESRF) may have elevated hsT levels, data on biological variability and the impact of...

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Autores principales: Wolley, Martin, Stewart, Ralph, Curry, Elizabeth, Davidson, James, White, Harvey, Pilmore, Helen
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4898328/
https://www.ncbi.nlm.nih.gov/pubmed/27293568
http://dx.doi.org/10.1093/ckj/sfs122
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author Wolley, Martin
Stewart, Ralph
Curry, Elizabeth
Davidson, James
White, Harvey
Pilmore, Helen
author_facet Wolley, Martin
Stewart, Ralph
Curry, Elizabeth
Davidson, James
White, Harvey
Pilmore, Helen
author_sort Wolley, Martin
collection PubMed
description BACKGROUND: A recently introduced high-sensitivity assay can measure troponin T (hsT) at low levels with greater precision than the fourth generation troponin T assay. As most patients with end-stage renal failure (ESRF) may have elevated hsT levels, data on biological variability and the impact of haemodialysis are needed for clinical interpretation of results. METHODS: This is a prospective observational cohort study aiming to identify baseline levels of hsT in stable haemodialysis patients in addition to examining variation in levels over time. Cardiovascular (CV) mortality was analysed at 6 months after the baseline hsT measurement. hsT was measured prior to the haemodialysis using the high-sensitivity Roche troponin T assay in 239 prevalent haemodialysis patients. In a subset of 78 patients, repeat measurements were made 1 month later, both before and after haemodialysis. RESULTS: hsT was above the 99th centile for the normal healthy population (14 ng/mL) in 98% of patients with a median level of 63 ng/L [Interquartile range (IQR) 37–108]. Higher hsT levels were associated with diabetes and left ventricular ejection fraction <50%. hsT was higher in patients who died from CV causes (median 418, IQR 109–776) compared with alive patients (median 59.5, IQR 36–96 P = 0.0027), and this association remained significant after adjustment for other predictors of mortality. In 95% of stable patients, variation in hsT over 1 month was <54%. In three patients with unstable coronary artery disease, hsT varied by >100% and >100 ng/L. Haemodialysis reduced hsT by a median of 24% (IQR 6–22, P = 0.0001). CONCLUSIONS: hsT levels are elevated in almost all patients with ESRF. Variation in hsT over 1 month was <50% in most patients. Greater variation may indicate an acute coronary syndrome or worsening cardiac disease.
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spelling pubmed-48983282016-06-10 Variation in and prognostic importance of troponin T measured using a high-sensitivity assay in clinically stable haemodialysis patients Wolley, Martin Stewart, Ralph Curry, Elizabeth Davidson, James White, Harvey Pilmore, Helen Clin Kidney J Original Contributions BACKGROUND: A recently introduced high-sensitivity assay can measure troponin T (hsT) at low levels with greater precision than the fourth generation troponin T assay. As most patients with end-stage renal failure (ESRF) may have elevated hsT levels, data on biological variability and the impact of haemodialysis are needed for clinical interpretation of results. METHODS: This is a prospective observational cohort study aiming to identify baseline levels of hsT in stable haemodialysis patients in addition to examining variation in levels over time. Cardiovascular (CV) mortality was analysed at 6 months after the baseline hsT measurement. hsT was measured prior to the haemodialysis using the high-sensitivity Roche troponin T assay in 239 prevalent haemodialysis patients. In a subset of 78 patients, repeat measurements were made 1 month later, both before and after haemodialysis. RESULTS: hsT was above the 99th centile for the normal healthy population (14 ng/mL) in 98% of patients with a median level of 63 ng/L [Interquartile range (IQR) 37–108]. Higher hsT levels were associated with diabetes and left ventricular ejection fraction <50%. hsT was higher in patients who died from CV causes (median 418, IQR 109–776) compared with alive patients (median 59.5, IQR 36–96 P = 0.0027), and this association remained significant after adjustment for other predictors of mortality. In 95% of stable patients, variation in hsT over 1 month was <54%. In three patients with unstable coronary artery disease, hsT varied by >100% and >100 ng/L. Haemodialysis reduced hsT by a median of 24% (IQR 6–22, P = 0.0001). CONCLUSIONS: hsT levels are elevated in almost all patients with ESRF. Variation in hsT over 1 month was <50% in most patients. Greater variation may indicate an acute coronary syndrome or worsening cardiac disease. Oxford University Press 2013-08 2012-11-07 /pmc/articles/PMC4898328/ /pubmed/27293568 http://dx.doi.org/10.1093/ckj/sfs122 Text en © The Author 2012. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For permissions, please email: journals.permissions@oup.com. http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Original Contributions
Wolley, Martin
Stewart, Ralph
Curry, Elizabeth
Davidson, James
White, Harvey
Pilmore, Helen
Variation in and prognostic importance of troponin T measured using a high-sensitivity assay in clinically stable haemodialysis patients
title Variation in and prognostic importance of troponin T measured using a high-sensitivity assay in clinically stable haemodialysis patients
title_full Variation in and prognostic importance of troponin T measured using a high-sensitivity assay in clinically stable haemodialysis patients
title_fullStr Variation in and prognostic importance of troponin T measured using a high-sensitivity assay in clinically stable haemodialysis patients
title_full_unstemmed Variation in and prognostic importance of troponin T measured using a high-sensitivity assay in clinically stable haemodialysis patients
title_short Variation in and prognostic importance of troponin T measured using a high-sensitivity assay in clinically stable haemodialysis patients
title_sort variation in and prognostic importance of troponin t measured using a high-sensitivity assay in clinically stable haemodialysis patients
topic Original Contributions
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4898328/
https://www.ncbi.nlm.nih.gov/pubmed/27293568
http://dx.doi.org/10.1093/ckj/sfs122
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