open access

Vol 27, No 4 (2020)
Original articles — Clinical cardiology
Published online: 2018-10-05
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High-sensitive troponin T increase after hemodialysis is associated with left ventricular global longitudinal strain and ultrafiltration rate

Serkan Ünlü, Asife Şahinarslan, Burak Sezenöz, Orhan Mecit Uludağ, Gökhan Gökalp, Özden Seçkin, Selim Turgay Arınsoy, Özlem Gülbahar, Nuri Bülent Boyacı
DOI: 10.5603/CJ.a2018.0118
·
Pubmed: 30338843
·
Cardiol J 2020;27(4):376-383.

open access

Vol 27, No 4 (2020)
Original articles — Clinical cardiology
Published online: 2018-10-05

Abstract

Background: Circulating troponin levels are both stable and higher in patients with end-stage renal disease, even in the absence of acute coronary syndrome. These patients commonly have underlying cardiac problems that frequently cause troponin elevation. The effect of hemodialysis (HD) on troponin levels has not been well elucidated. Thus, investigated herein is the relationship between the changes in troponin levels along with left ventricular deformation and volume depletion in patients with end-stage
renal disease.
Methods: Patients included were between 18 and 85 years of age and were receiving hemodialysis for at least 6 months. High sensitive cardiac troponin T (hs-cTnT) levels were studied in blood samples taken at the beginning and end of HD. Two-dimensional speckle tracking strain imaging was used to evaluate myocardial contractility.
Results: Seventy patients (50.7 ± 16.9 years of age, 27 women) were included in study. The mean volume of ultrafiltration was 3260 ± 990 mL. A significant increase in circulating hs-cTnT levels was observed, as well as a prominent decrease in left ventricular global longitudinal strain (GLS) after HD (52.4 ± 40.2 ng/L vs. 66.8 ± 48.5 ng/L, p < 0.001 and 20.1 ± 3.6% vs. 16.8 ± 3.8% p < 0.001, respectively). Moreover, ultrafiltration rate and GLS were found as the strongest independent variables in relation to the relative increase in hs-cTnT.
Conclusions: Hemodialysis can cause a significant increase in hsTnT. This can jeopardize the accuracy of clinical diagnoses based on hs-TnT measurements. GLS may be used as a determinant of this hs-TnT increase. The influence of HD on the cardiovascular system should be kept in mind to prevent unnecessary interventions.

Abstract

Background: Circulating troponin levels are both stable and higher in patients with end-stage renal disease, even in the absence of acute coronary syndrome. These patients commonly have underlying cardiac problems that frequently cause troponin elevation. The effect of hemodialysis (HD) on troponin levels has not been well elucidated. Thus, investigated herein is the relationship between the changes in troponin levels along with left ventricular deformation and volume depletion in patients with end-stage
renal disease.
Methods: Patients included were between 18 and 85 years of age and were receiving hemodialysis for at least 6 months. High sensitive cardiac troponin T (hs-cTnT) levels were studied in blood samples taken at the beginning and end of HD. Two-dimensional speckle tracking strain imaging was used to evaluate myocardial contractility.
Results: Seventy patients (50.7 ± 16.9 years of age, 27 women) were included in study. The mean volume of ultrafiltration was 3260 ± 990 mL. A significant increase in circulating hs-cTnT levels was observed, as well as a prominent decrease in left ventricular global longitudinal strain (GLS) after HD (52.4 ± 40.2 ng/L vs. 66.8 ± 48.5 ng/L, p < 0.001 and 20.1 ± 3.6% vs. 16.8 ± 3.8% p < 0.001, respectively). Moreover, ultrafiltration rate and GLS were found as the strongest independent variables in relation to the relative increase in hs-cTnT.
Conclusions: Hemodialysis can cause a significant increase in hsTnT. This can jeopardize the accuracy of clinical diagnoses based on hs-TnT measurements. GLS may be used as a determinant of this hs-TnT increase. The influence of HD on the cardiovascular system should be kept in mind to prevent unnecessary interventions.

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Keywords

dialysis, high-sensitive, load, speckle, troponin

About this article
Title

High-sensitive troponin T increase after hemodialysis is associated with left ventricular global longitudinal strain and ultrafiltration rate

Journal

Cardiology Journal

Issue

Vol 27, No 4 (2020)

Pages

376-383

Published online

2018-10-05

DOI

10.5603/CJ.a2018.0118

Pubmed

30338843

Bibliographic record

Cardiol J 2020;27(4):376-383.

Keywords

dialysis
high-sensitive
load
speckle
troponin

Authors

Serkan Ünlü
Asife Şahinarslan
Burak Sezenöz
Orhan Mecit Uludağ
Gökhan Gökalp
Özden Seçkin
Selim Turgay Arınsoy
Özlem Gülbahar
Nuri Bülent Boyacı

References (30)
  1. Thygesen K, Alpert J, Jaffe A, et al. Third universal definition of myocardial infarction. Nat Rev Cardiol. 2012; 9(11): 620–633.
  2. Westermann D, Neumann JT, Sörensen NA, et al. High-sensitivity assays for troponin in patients with cardiac disease. Nat Rev Cardiol. 2017; 14(8): 472–483.
  3. Apple FS, Collinson PO. Analytical characteristics of high-sensitivity cardiac troponin assays. Clin Chem. 2012; 58(1): 54–61.
  4. Roffi M, Patrono C, Collet JP, et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J. 2016; 37(3): 267–315.
  5. Hassan HC, Howlin K, Jefferys A, et al. High-sensitivity troponin as a predictor of cardiac events and mortality in the stable dialysis population. Clin Chem. 2014; 60(2): 389–398.
  6. Mishra RK, Li Y, DeFilippi C, et al. CRIC Study Investigators. Association of cardiac troponin T with left ventricular structure and function in CKD. Am J Kidney Dis. 2013; 61(5): 701–709.
  7. Pianta TJ, Horvath AR, Ellis VM, et al. Cardiac high-sensitivity troponin T measurement: a layer of complexity in managing haemodialysis patients. Nephrology (Carlton). 2012; 17(7): 636–641.
  8. Kumar N, Michelis MF, DeVita MV, et al. Troponin I levels in asymptomatic patients on haemodialysis using a high-sensitivity assay. Nephrol Dial Transplant. 2011; 26(2): 665–670.
  9. deFilippi C, Wasserman S, Rosanio S, et al. Cardiac troponin T and C-reactive protein for predicting prognosis, coronary atherosclerosis, and cardiomyopathy in patients undergoing long-term hemodialysis. JAMA. 2003; 290(3): 353–359.
  10. Yakupoglu U, Ozdemir FN, Arat Z, et al. Can troponin-I predict cardiovascular mortality due to myocardial injury in hemodialysis patients? Transplant Proc. 2002; 34(6): 2033–2034.
  11. Apple FS, Murakami MM, Pearce LA, et al. Predictive value of cardiac troponin I and T for subsequent death in end-stage renal disease. Circulation. 2002; 106(23): 2941–2945.
  12. Fredericks S, Chang R, Gregson H, et al. Circulating cardiac troponin-T in patients before and after renal transplantation. Clin Chim Acta. 2001; 310(2): 199–203.
  13. Chen M, Gerson H, Eintracht S, et al. Effect of Hemodialysis on Levels of High-Sensitivity Cardiac Troponin T. Am J Cardiol. 2017; 120(11): 2061–2064.
  14. Dasselaar JJ, Slart RH, Knip M, et al. Haemodialysis is associated with a pronounced fall in myocardial perfusion. Nephrol Dial Transplant. 2009; 24(2): 604–610.
  15. Burton JO, Jefferies HJ, Selby NM, et al. Hemodialysis-induced cardiac injury: determinants and associated outcomes. Clin J Am Soc Nephrol. 2009; 4(5): 914–920.
  16. Bemelmans RHH, Boerma EC, Barendregt J, et al. Changes in the volume status of haemodialysis patients are reflected in sublingual microvascular perfusion. Nephrol Dial Transplant. 2009; 24(11): 3487–3492.
  17. Hensen LCR, Goossens K, Delgado V, et al. Prognostic implications of left ventricular global longitudinal strain in predialysis and dialysis patients. Am J Cardiol. 2017; 120(3): 500–504.
  18. Krishnasamy R, Isbel NM, Hawley CM, et al. Left ventricular global longitudinal strain (GLS) is a superior predictor of all-cause and cardiovascular mortality when compared to ejection fraction in advanced chronic kidney disease. PLoS One. 2015; 10(5): e0127044.
  19. Lang R, Badano L, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2015; 16(3): 233–271.
  20. Peetz D, Schütt S, Sucké B, et al. Prognostic value of troponin T, troponin I, and CK-MBmass in patients with chronic renal failure. Med Klin (Munich). 2003; 98(4): 188–192.
  21. Schmidt A, Stefenelli T, Schuster E, et al. Informational contribution of noninvasive screening tests for coronary artery disease in patients on chronic renal replacement therapy. Am J Kidney Dis. 2001; 37(1): 56–63.
  22. Conway B, McLaughlin M, Sharpe P, et al. Use of cardiac troponin T in diagnosis and prognosis of cardiac events in patients on chronic haemodialysis. Nephrol Dial Transplant. 2005; 20(12): 2759–2764.
  23. Mavrakanas TA, Sniderman AD, Barré PE, et al. High ultrafiltration rates increase troponin levels in stable hemodialysis patients. Am J Nephrol. 2016; 43(3): 173–178.
  24. Ellis K, Dreisbach AW, Lertora JL. Plasma elimination of cardiac troponin I in end-stage renal disease. South Med J. 2001; 94(10): 993–996.
  25. Daugirdas J, Depner T, Inrig J, et al. KDOQI Clinical Practice Guideline for Hemodialysis Adequacy: 2015 Update. Am J Kidney Dis. 2015; 66(5): 884–930.
  26. Voigt JU, Pedrizzetti G, Lysyansky P, et al. Definitions for a Common Standard for 2D Speckle Tracking Echocardiography: Consensus Document of the EACVI/ASE/Industry Task Force to Standardize Deformation Imaging. J Am Soc Echocardiogr. 2015; 28(2): 183–193.
  27. Galderisi M, Cosyns B, Edvardsen T, et al. Standardization of adult transthoracic echocardiography reporting in agreement with recent chamber quantification, diastolic function, and heart valve disease recommendations: an expert consensus document of the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2017; 18(12): 1301–1310.
  28. Farsalinos KE, Daraban AM, Ünlü S, et al. Head-to-Head Comparison of Global Longitudinal Strain Measurements among Nine Different Vendors: The EACVI/ASE Inter-Vendor Comparison Study. J Am Soc Echocardiogr. 2015; 28(10): 1171–1181, e2.
  29. Saenger AK, Beyrau R, Braun S, et al. Multicenter analytical evaluation of a high-sensitivity troponin T assay. Clin Chim Acta. 2011; 412(9-10): 748–754.
  30. Fahim MA, Hayen AD, Horvath AR, et al. Biological variation of high sensitivity cardiac troponin-T in stable dialysis patients: implications for clinical practice. Clin Chem Lab Med. 2015; 53(5): 715–722.

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