Troponin T for the detection of dialysis-induced myocardial stunning in hemodialysis patients

Tobias Breidthardt, James O. Burton, Aghogho Odudu, Mohamed Tarek Eldehni, Helen J. Jefferies, Christopher W. McIntyre

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    Background and objectives Circulating troponin T levels are frequently elevated in patients undergoing long-term dialysis. The pathophysiology underlying these elevations is controversial. Design, setting, participants, & measurements In 70 prevalent hemodialysis (HD) patients, HD-induced myocardial stunningwas assessed echocardiographically at baseline and after 12months.Nineteen patientswere not available for the follow-up analysis. The extent to which predialysis troponin T was associated with the occurrence of HD-induced myocardial stunning was assessed as the primary endpoint. Results The median troponin T level in this hemodialysis cohort was 0.06 ng/ml (interquartile range, 0.02-0.10). At baseline, 64% of patients experienced myocardial stunning. These patients showed significantly higher troponin T levels than patients without stunning (0.08 ng/ml [0.05-0.12] versus 0.02 ng/ml [0.01-0.05]). Troponin T levels were significantly correlated to measures of myocardial stunning severity (number of affected segments: r=0.42; change in ejection fraction from beginning of dialysis to end of dialysis: r=20.45). In receiveroperating characteristic analyses, predialytic troponin T achieved an area under the curve of 0.82 for the detection of myocardial stunning. In multivariable analysis, only ultrafiltration volume (odds ratio, 4.38 for every additional liter) and troponin T (odds ratio, 9.33 for every additional 0.1 ng/ml) were independently associated with myocardial stunning. After 12 months, nine patients had newly developed myocardial stunning and showed a significant increase in troponin T over baseline (0.03 ng/ml at baseline versus 0.05 ng/ml at year 1). Conclusions Troponin T levels in HD patients are associated with the presence and severity of HD-induced myocardial stunning. © 2012 by the American Society of Nephrology.
    Original languageEnglish
    Pages (from-to)1285-1292
    Number of pages7
    JournalClinical Journal of the American Society of Nephrology
    Issue number8
    Publication statusPublished - Aug 2012


    • Aged
    • Biological Markers/blood
    • England
    • Female
    • Humans
    • Logistic Models
    • Male
    • Middle Aged
    • Multivariate Analysis
    • Myocardial Stunning/blood/*diagnosis/etiology/ultrasonography
    • Odds Ratio
    • Predictive Value of Tests
    • ROC Curve
    • Renal Dialysis/*adverse effects
    • Risk Assessment
    • Risk Factors
    • Severity of Illness Index
    • Time Factors
    • Troponin T/*blood
    • Up-Regulation


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