Key result
High concentrations (4th quartile) of hs-cTnT and hs-cTnI were associated with increased mortality (HR 5.2, 95% CI 2.7-9.8 for hs-cTnT; HR 3.8, 95% CI 2.2-6.8 for hs-cTnI) in hemodialysis patients.
Why the study?
End-stage renal disease is associated with a high risk of cardiovascular disease, prompting a comparison of the concentration and prognostic ability of hs-cTnT, hs-cTnI, and cMyC in stable hemodialysis patients.
Do elevated concentrations of hs-cTnT, hs-cTnI, and cMyC predict mortality and cardiovascular events in stable hemodialysis patients?
Cohort (n=307)
Do elevated concentrations of hs-cTnT, hs-cTnI, and cMyC predict mortality and cardiovascular events in stable hemodialysis patients?
Hazard Ratio: 5.2 (95% CI 2.7–9.8)
Elevated levels of hs-cTnT and hs-cTnI, but not cMyC, are strongly associated with increased mortality and cardiovascular events in stable hemodialysis patients.
hs-cTnT/I and cMyC may stratify mortality risk in stable hemodialysis; leaves open incremental value over standard markers.
OBJECTIVES: End-stage renal disease is associated with a high risk of cardiovascular disease. We compared the concentration and prognostic ability of high sensitivity cardiac troponin T (hs-cTnT) and I (hs-cTnI) and cardiac myosin-binding protein C (cMyC) among stable hemodialysis patients. METHODS: Patients were sampled before and after hemodialysis. We measured hs-cTnI, hs-cTnT and cMyC and used Cox regressions to assess the association between quartiles of concentrations and all-cause mortality and a combination of cardiovascular events and all-cause mortality during follow-up. RESULTS: A total of 307 patients were included, 204 males, mean age 66 years (SD 14). Before dialysis, 299 (99 %) had a hs-cTnT concentration above the 99th percentile, compared to 188 (66 %) for cMyC and 35 (11 %) for hs-cTnI. Hs-cTnT (23 %, p<0.001) and hs-cTnI (15 %, p=0.049) but not cMyC (4 %, p=0.256) decreased during dialysis. Follow-up was a median of 924 days (492-957 days); patients in the 3rd and 4th quartiles of hs-cTnT (3rd:HR 3.0, 95 % CI 1.5-5.8, 4th:5.2, 2.7-9.8) and the 4th quartile of hs-cTnI (HR 3.8, 2.2-6.8) had an increased risk of mortality. Both were associated with an increased risk of the combined endpoint for patients in the 3rd and 4th quartiles. cMyC concentrations were not associated with risk of mortality or cardiovascular event. CONCLUSIONS: Hs-cTnT was above the 99th percentile in almost all patients. This was less frequent for hs-cTnI and cMyC. High cTn levels were associated with a 3-5-fold higher mortality. This association was not present for cMyC. These findings are important for management of hemodialysis patients.
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Hasselbalch et al. (2023) conducted a cohort in End-stage renal disease on stable hemodialysis (n=307). High sensitivity cardiac troponin T (hs-cTnT) and I (hs-cTnI) and cardiac myosin-binding protein C (cMyC) vs. Lower quartiles of biomarker concentrations was evaluated on All-cause mortality (HR 5.2, 95% CI 2.7-9.8). High concentrations (4th quartile) of hs-cTnT and hs-cTnI were associated with increased mortality (HR 5.2, 95% CI 2.7-9.8 for hs-cTnT; HR 3.8, 95% CI 2.2-6.8 for hs-cTnI) in hemodialysis patients.
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