FREQUENCY OF ELEVATED TROPONIN T IN PATIENTS OF CHRONIC RENAL FAILURE WITHOUT CLINICALLY SUSPECTED ACUTE MYOCARDIAL INFARCTION

Authors

  • Syed Affan Ali Abbottabad International Medical College
  • Sumera Kazmi Abbottabad International Medical College
  • Mir Jalal-ud-din Women Medical College, DHQ Teaching Hospital, Abbottabad
  • Muhammad Iqbal Qasim
  • Zahid Gul Jadoon

Abstract

Background: Cardiac Troponins are established markers of myocardial injury; however, they may be elevated in chronic renal failure (CRF) patients even in absence of acute myocardial infarction. The objective of the study was to determine the frequency of elevated Troponin T in patients of chronic renal failure without clinically suspected acute myocardial infarction. Methods: This cross-sectional study was conducted at Medical B Unit of Ayub Teaching Hospital, Abbottabad from 16th December 2013 to 16th June 2014. A sample of 117 patients of chronic renal failure was included in the study without any gender discrimination. The patients were defined as known chronic renal failure when renal failure was reported in their past medical history and by estimation of glomerular filtration rate (GFR). Those patients who had raised Troponin T due to any other reason like acute myocardial ischemia (chest pain, electrocardiographic changes and greater than 20% elevation in Troponin T from baseline), sepsis, heart failure and those who were receiving cardiotoxic chemotherapy were excluded. The subjects were enrolled by non-probability consecutive sampling. Results were analysed by SPSS 16.0 Results: Out of 117 participants, 72 (61.5%) were males and 45 (38.5%) were females. The mean age of the study participants was 52.08±14.21 years. Elevated Troponin T was found in 45 (38.5%) of the patients. There is statistically significant association between the stage of CRF and elevated levels of Troponin T. Statistically significant negative correlation (r=-0.213,p=0.021) was found between the Glomerular Filtration Rate and serum levels of Troponin T. Conclusion: A high proportion of CRF patients have elevated Troponin T and the rise is significantly associated with the stage of chronic renal failure.Keywords: Chronic renal failure, Troponin T, Acute myocardial infarction

Author Biographies

Syed Affan Ali, Abbottabad International Medical College

Assistant Professor, Medicine Department

Sumera Kazmi, Abbottabad International Medical College

Associate professor, Medicine

Mir Jalal-ud-din, Women Medical College, DHQ Teaching Hospital, Abbottabad

Associate Professor, Medicine

References

de Winter RJ, Koster RW, Sturk A, Sanders GT. Value of myoglobin, troponin T, and CK-MB mass in ruling out an acute myocardial infarction in the emergency room. Circulation 1995; 92(12):3401–7.

Longmore M, Wilkinson I, Edward H. Davidson, Alexander Foulkes. Mafi AR, editor. In: Oxford Handbook of Clinical Medicine. 8th ed. England. Oxford University Press, 2010; p.608–25.

Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K , Aboyans V, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012;380(9859):2095–128.

Zollo AJ, Prabhakar SS. Nephrology. In: Medical Secrets. 4th ed. USA: Elsevier, 2006; p.244.

Freda BJ, Tang WH, Van LF, Peacock WF, Francis GS. Cardiac troponins in renal insufficiency: review and clinical implications. J Am Coll Cardiol 2002;40(12):2065–71.

Ooi DS, Isotalo PA, Veinot JP. Correlation of antemortem serum creatine kinase, creatine kinase-MB, Troponin I and Troponin T with cardiac pathology. Clin Chem 2000;46(3):338–44.

Sato Y, Yamada T, Taniguchi R, Nagai K, Makiyama T, Okada H, et al. Persistently increased serum concentrations of cardiac troponin T in patients with idiopathic dilated cardiomyopathy are predictive of adverse outcomes. Circulation 2001;103(3):369–74.

Wu AH, Jaffe AS, Apple FS, Jesse RL, Francis GL, Morrow DA, et al. National Academy of Clinical Biochemistry laboratory medicine practice guidelines: use of cardiac troponin and B-type natriuretic peptide or N-terminal proB-type natriuretic peptide for etiologies other than acute coronary syndromes and heart failure. Clin Chem 2007;53(12):2086–96.

Lwanga SK, Lemeshow S. Sample size determination in health studies-A practical manual. Geneva: World Health Organization, 1991; p.80.

Blich M, Sebbag A, Attias J, Aronson D, Markiewicz W. Cardiac troponin elevation in hospitalized patients without acute coronary syndromes. Am J Cardiol 2008;101(10):1384–88.

Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 1999; 130 (6):461–70.

Apple FS, Murakami MM, Pearce LA, Herzog CA. Predictive value of cardiac troponin I and T for subsequent death in end-stage renal disease. Circulation 2002; 106 (23):2941–5.

Dierkes J, Domrose U, Westphal S, Ambrosch A, Bosselmann HP, Neumann KH, et al. Cardiac troponin T predicts mortality in patients with end-stage renal disease. Circulation 2000; 102 (16):1964–9.

Ahmadi F, Dolatkhani F, Lessan-Pezeshki M, Mahdavi-Mazdeh M, Abbasi MR, Mohebi-Nejad A. Cardiac troponins in patients with chronic kidney disease and kidney transplant recipients without acute cardiac symptoms. Iran J Kidney Dis 2014;8 (1):31–6.

Choy JB, Armstrong PW, Ulan RA, Campbell PM, Gourishankar S, Prosser CI, et al. Do cardiac troponins provide prognostic insight in haemodialysis patients? Can J Cardiol 2003;19 (8):907–11.

Musso P, Cox I, Vidano E, Zambon D, Panteghini M. Cardiac troponin elevations in chronic renal failure: prevalence and clinical significance. Clin Biochem 1999;32(2):125–30.

Ooi DS, House AA. Cardiac Troponin T in hemodialyzed patients. Clin Chem 1998; 44(7):1410–6.

Dubin RF, Li Y, He J, jaar BG, Kallem R, Lash JP, et al. Predictors of high sensitivity cardiac troponin T in chronic kidney disease patients: a cross-sectional study in the chronic renal insufficiency cohort (CRIC). BMC Nephrol 2013;14: 229.

Abbas NA, John RI, Webb MC, Kempson ME, Potter AN, Price CP, et al. Cardiac Troponins and Renal Function in Nondialysis Patients with Chronic Kidney Disease. Clin Chem 2005; 51(11):2059–66.

Lamb EJ, Webb MC, Abbas NA. The significance of serum troponin T in patients with kidney disease: a review of the literature. Ann Clin Biochem 2004;41(Pt 1):1–9.

Published

2019-08-02

Most read articles by the same author(s)