Linlin Sun1, Yongqiang Ji2, Yonglan Wang3, Miao Ding3, Xinmiao Xie3, Dingyu Zhu3, Fuhua Chen3, Nan Zhang3, Xiaoxia Wang4. 1. Department of Nephrology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China. llsunzj@sina.com. 2. Department of Nephrology, Yuhuangding Hospital, Qingdao University Medical College, Yantai, 264000, China. 3. Department of Nephrology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China. 4. Department of Nephrology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China. omaha198501@163.com.
Abstract
OBJECTIVE: To identify the relationship between serum high-sensitive cardiac troponin T (hs-cTnT) and left ventricular diastolic dysfunction (LVDD) among maintenance hemodialysis patients and to further explore the value of hs-cTnT in evaluating and predicting LVDD in this special group of patients. METHODS: In a cross-sectional study, 152 dialysis patients with end-stage renal disease (ESRD) underwent Hs-cTnT measurement using the high sensitivity assay. Echocardiography measurements were carried out according to the American Society of Echocardiography recommendations and E/E' > 15 or E' < 7 cm/s was defined as diastolic dysfunction. Demographic, biochemical, and echocardiographic values of left ventricular mass index (LVMI), left ventricular ejection fraction (LVEF), left atrial diameter, early/late peak velocities ratio (E/A), early peak diastolic annular velocity (E') and E/E' were compared across quartiles of hs-cTnT. The association of plasma hs-cTnT concentrations with echocardiographic parameters was analyzed by Spearman's correlation. The relationship between serum hs-cTnT and LVDD parameters of E/E' and E' was analyzed using multivariate regression analysis, and the value of hs-cTnT on assessing LVDD was evaluated by receiver-operating characteristic (ROC) curves. RESULTS: The median value of hs-cTnT was 45 pg/ml (range 28-73). All patients had detectable hs-cTnT, while 88% had greater hs-cTnT than the 99th percentile of the general population (14 pg/ml). Serum hs-cTnT values showed a significantly positive correlation with E/E' (r = 0.739, p < 0.001) and LVMI (r = 0.608, p < 0.001), but showed a negative correlation with E' (r = - 0.554, p < 0.001). Serum hs-cTnT was not associated with LV systolic dysfunction. The associations of hs-cTnT with E/E' and E' persisted after multivariate adjustment for LVMI and comorbidities. In logistic multiple regression analysis, compared with the lowest quartile of hs-cTnT, the highest two quartiles were approximately 5 and 11 times more likely to have E/E' > 15 and 7 and 17 times more likely to have E' < 7 cm/s. The area under the ROC curve for hs-cTnT evaluating E/E' > 15 was 0.847 and evaluating E' < 7 cm/s was 0.799, which denoted a moderate accuracy. CONCLUSIONS: Our studies suggest that serum hs-cTnT may serve as a biomarker of LVDD in hemodialysis patients.
OBJECTIVE: To identify the relationship between serum high-sensitive cardiac troponin T (hs-cTnT) and left ventricular diastolic dysfunction (LVDD) among maintenance hemodialysis patients and to further explore the value of hs-cTnT in evaluating and predicting LVDD in this special group of patients. METHODS: In a cross-sectional study, 152 dialysis patients with end-stage renal disease (ESRD) underwent Hs-cTnT measurement using the high sensitivity assay. Echocardiography measurements were carried out according to the American Society of Echocardiography recommendations and E/E' > 15 or E' < 7 cm/s was defined as diastolic dysfunction. Demographic, biochemical, and echocardiographic values of left ventricular mass index (LVMI), left ventricular ejection fraction (LVEF), left atrial diameter, early/late peak velocities ratio (E/A), early peak diastolic annular velocity (E') and E/E' were compared across quartiles of hs-cTnT. The association of plasma hs-cTnT concentrations with echocardiographic parameters was analyzed by Spearman's correlation. The relationship between serum hs-cTnT and LVDD parameters of E/E' and E' was analyzed using multivariate regression analysis, and the value of hs-cTnT on assessing LVDD was evaluated by receiver-operating characteristic (ROC) curves. RESULTS: The median value of hs-cTnT was 45 pg/ml (range 28-73). All patients had detectable hs-cTnT, while 88% had greater hs-cTnT than the 99th percentile of the general population (14 pg/ml). Serum hs-cTnT values showed a significantly positive correlation with E/E' (r = 0.739, p < 0.001) and LVMI (r = 0.608, p < 0.001), but showed a negative correlation with E' (r = - 0.554, p < 0.001). Serum hs-cTnT was not associated with LV systolic dysfunction. The associations of hs-cTnT with E/E' and E' persisted after multivariate adjustment for LVMI and comorbidities. In logistic multiple regression analysis, compared with the lowest quartile of hs-cTnT, the highest two quartiles were approximately 5 and 11 times more likely to have E/E' > 15 and 7 and 17 times more likely to have E' < 7 cm/s. The area under the ROC curve for hs-cTnT evaluating E/E' > 15 was 0.847 and evaluating E' < 7 cm/s was 0.799, which denoted a moderate accuracy. CONCLUSIONS: Our studies suggest that serum hs-cTnT may serve as a biomarker of LVDD in hemodialysis patients.
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