How do plasma levels of cardiac troponins T and I compare in chronically hemodialyzed patients in relation to coronary heart disease status and age?
In chronic hemodialysis patients, cTnT is more frequently elevated than cTnI in the absence of coronary heart disease, and these elevations are amplified by advanced age, likely reflecting subclinical cardiac lesions.
Cardiac troponins (cTnT and cTnI) are useful tools for risk stratification in patients with unstable angina. However, their value in patients with renal failure has been questioned. In this study, we determined cTnT and cTnI at 3-month intervals during 9 months in 97 chronic renal failure (CRF) patients treated with hemodialysis. cTnT was measured using a third generation immunoassay and cTnI by fluorimetric immunoassay with a detection limit similar to that of cTnT (0.01 microg/l). In the renal patients without coronary heart disease (CHD(-) group), cTnT was more frequently elevated above cut-off for acute myocardial infarction (AMI) (up to 21.6%) than cTnI (no patient). In the absence of CHD, cTnT levels were positively correlated to age, and more than half of the CHD(-) patients aged over 60 years had cTnT levels above the upper reference limit (URL) of 0.04 microg/l (0.059+/-0.042 microg/l). cTnI increased with age in parallel to cTnT but mean levels did not exceed the URL of 0.08 microg/l in the CHD(-) patients aged over 60 years (0.036+/-0.031 microg/l). In the patients with documented cardiac events (CHD(+)) we found higher troponin levels than in the CHD(-) patients of the corresponding age, but for cTnl the differences between CHD(+) and CHD(-) patients were significant in the patients aged < or =60 years only (0.049+/-0.054 vs. 0.019+/-0.018 microg/l, p<0.05). For cTnT, the differences between patients with and without coronary events also tended to be less important in the eldest patients. There was a significant correlation between cTnI and cTnT levels in the CHD(-) and in the CHD(+) groups. Changes in the plasma levels of cardiac troponins are common in hemodialysis patients in the absence of CHD, and advanced age appears to amplify these changes. The reason could be that most hemodialysis patients with advanced age have subclinical lesions and demonstrate release characteristics of troponins that compare to those in patients with symptomatic coronary events. Therefore, it will be important to analyze troponin elevations above the URL or above the cut-off concentration for AMI in asymptomatic renal patients in relation to prognosis.
Chapelle et al. (2002) studied this question.