Addition of hs-cTnT to clinical and echocardiographic variables significantly improved risk reclassification for cardiovascular events (NRI 44.6%; 95% CI 15.9-74.3%; p<0.001) in hemodialysis patients.
Cohort (n=181)
No
Does high-sensitive cardiac troponin T (hs-cTnT) predict cardiovascular outcomes and all-cause mortality better than echocardiographic parameters in stable maintenance hemodialysis patients?
hs-cTnT is a powerful independent predictor of cardiovascular outcomes and all-cause mortality in stable maintenance hemodialysis patients, outperforming routine echocardiographic parameters for risk stratification.
Effect estimate: NRI 44.6% (95% CI 15.9-74.3%)
p-value: p=< 0.001
BACKGROUND: Hemodialysis patients, who are often excluded from cardiovascular (CV) clinical trials, are associated with higher CV morbidity and mortality. The risk stratification scheme for these patients is lacking. Therefore, this investigation examined the independent CV prognostic value of high-sensitive cardiac troponin T (hs-cTnT) and added prognostic value over echocardiographic parameters and other clinical risk predictors in asymptomatic stable maintenance hemodialysis (MHD) patients. METHODS: 181 patients with end-stage renal disease undergoing MHD were eligible from the dialysis center of Tongren Hospital, Shanghai Jiao Tong University School of Medicine between October 2017 and September 2018. These patients were followed until September 2020 or until death. The median follow-up was 31 (IQR: 21-33) months. Outcome measures were all-cause mortality, first fatal or nonfatal CV events (CVEs), and 4-point composite major adverse CVEs (MACE). We performed multivariable Cox regression analysis using demographic, clinical, laboratory, and echocardiographic data to identify predictors of CV outcomes. We also evaluated the increased discriminative value associated with the addition of echocardiographic parameters and hs-cTnT using net reclassification improvement (NRI) and integrated discrimination improvement (IDI). RESULTS: During follow-up, 37 patients died, 84 patients suffered one or more CVEs, and 78 patients developed 4-point MACE. In univariable analyses, age, dialysis vintage, diastolic blood pressure, parathyroid hormone concentrations, hs-cTnT, B-type natriuretic peptide, left ventricular mass index (LVMI), and E/E' predicted all end points. hs-cTnT remained a strong predictor for each end point in multivariate analysis, whereas LVMI and E/E' did not. The addition of hs-cTnT on top of clinical and echocardiographic variables was associated with improvements in reclassification for CVEs (NRI = 44.6% 15.9-74.3%, IDI = 15.9% 5.7-31.0%, all p 0.05). CONCLUSIONS: Our data suggest that hs-cTnT is a powerful independent predictor of CV outcome and all-cause mortality in stable MHD patients. The additional use of echocardiography for improvement of risk stratification is not supported by our results.
Sun et al. (Fri,) conducted a cohort in End-stage renal disease undergoing maintenance hemodialysis (n=181). High-sensitive cardiac troponin T (hs-cTnT) vs. Clinical and echocardiographic variables alone was evaluated on Cardiovascular events (CVEs) (NRI 44.6%, 95% CI 15.9-74.3%, p=< 0.001). Addition of hs-cTnT to clinical and echocardiographic variables significantly improved risk reclassification for cardiovascular events (NRI 44.6%; 95% CI 15.9-74.3%; p<0.001) in hemodialysis patients.