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Cardiac Troponin Testing in Renal Failure and Skeletal Muscle Disease Patients

  • Chapter
Cardiac Markers

Part of the book series: Pathology and Laboratory Medicine ((PLM))

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Abstract

Cardiac disease is a major cause of death in patients with end-stage renal disease (ESRD), responsible for up to 45% of overall mortality (1,2).Approximately 25% of deaths from cardiac causes are due to acute myocardial infarction (AMI). The overall mortality after AMI among 34,000 patients on long-term hemodialysis, identified form the US Renal Data System database, was 59% at 1 yr, 73% at 2 yr, and 89% at 5 yr (1). Furthermore, the mortality rate after AMI was substantially greater for patients on longterm dialysis than for renal transplant recipients. Thus, sudden death and cardiac death are common occurrences in chronic hemodialysis patients. Based on data for approx 325,000 deaths from 1977 through 1997 recorded by the US Renal Data System database, Mondays and Tuesdays were the most common days for sudden and cardiac death for hemodialysis patients (3). Approximately 20% of deaths occurred on Mondays and Tuesdays, compared to 14% on Wednesdays through Saturdays. The intermittent nature of hemodialysis, accompanied by large weight gains, increased potassium concentrations, and post-dialysis hypotension on Mondays and Tuesdays likely contributed to the differences in cardiac death rates. These data support the hypothesis that more aggressive strategies may be beneficial for the prevention of AMI in patients on dialysis.

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References

  1. Herzog CA, Ma JZ, Collins AJ. Poor long-term survival after acute myocardial infraction among patients on long-term dialysis. N Engl J Med 1998; 339: 799–805.

    Article  PubMed  CAS  Google Scholar 

  2. Herzog CA. Diagnosis and treatment of ischemic heart disease in dialysis patients. Curr Opin Neph Hyper 1997; 6: 558–565.

    Article  CAS  Google Scholar 

  3. Bleyer AJ, Russell GB, Satko SG. Sudden and cardiac death rates in hemodialysis patients. Kid Int 1999; 55: 1553–1559.

    Article  CAS  Google Scholar 

  4. Hoffman EP, Fishbeck KH, Brown RH, et al. Characterization of dystrophy in muscle biopsy specimens from patient’s with Duchenne’s or Becker’s muscular dystrophy. N Engl J Med 1988; 318: 1363–1368.

    Article  PubMed  CAS  Google Scholar 

  5. Anderson PAW, Malouf NN, Oakley AE, Pagani ED, Allen PD. Troponin T isoform expression in humans: a comparison among normal and failing adult heart, fetal heart, and adult and fetal skeletal muscle. Circ Res 1991; 69: 1226–1233.

    Article  PubMed  CAS  Google Scholar 

  6. Wilkinson JM, Grand JA. Comparison of amino acid sequence of troponin I from different striated muscles. Nature 1978; 271: 31–35.

    Article  PubMed  CAS  Google Scholar 

  7. Bodor GS, Porterfield D, Voss EM, Smith S, Apple FS. Cardiac troponin I is not expressed in fetal and healthy or diseased adult human skeletal tissue. Clin Chem 1995; 41: 1710–1715.

    PubMed  CAS  Google Scholar 

  8. Ricchiuti V, Voss EM, Ney A, Odland M, Anderson PAW, Apple FS. Cardiac troponin T isoforms expressed in renal diseased skeletal muscle will not cause false-positive results by the second generation cardiac troponin T assay by Boehringer Mannheim. Clin Chem 1998; 44: 1919–1924.

    PubMed  CAS  Google Scholar 

  9. Ricchiuti V, Apple FS. RNA expression of cardiac troponin T isoforms in diseased human skeletal muscle. Clin Chem 1999; 45: 2129–2135.

    PubMed  CAS  Google Scholar 

  10. Hammer-Lercher A, Erlacher P, Bittner R, et al. Clinical and experimental results on cardiac troponin expression in Duchenne muscular dystrophy. Clin Chem 2001; 47: 451–458.

    Google Scholar 

  11. Erlacher P, Lercher A, Falkensammer J, et al. Cardiac troponin and beta-type myosin heavy chain concentrations in patients with polymyositis or dermatomyositis. Clin Chim Acta 2001; 306: 27–33.

    Article  PubMed  CAS  Google Scholar 

  12. Fredricks S, Murray JF, Bewick M, et al. Cardiac troponin T and creatine kinase MB are not increased in exterior oblique muscle of patients with renal failure. Clin Chem 2001; 47: 1023–1030.

    Google Scholar 

  13. Davis GK, Labugger R, Van Eyk JE, Apple FS. Cardiac troponin T is not detected in Western blots of diseased renal disease. Clin Chem 2001; 47: 782–784.

    PubMed  CAS  Google Scholar 

  14. Davis GK, Labugger R, Van Eyk JE, Apple FS. Cardiac troponin T is not detected in Western blot of diseased renal tissue. Clin Chem 2001; 47: 782–784.

    PubMed  CAS  Google Scholar 

  15. Bodor GS, Survant L, Voss EM, Smith S, Porterfield D, Apple FS. Cardiac troponin T composition in normal and regenerating skeletal muscle. Clin Chem 1997; 43: 476–484.

    PubMed  CAS  Google Scholar 

  16. Haller C, Zehelein J, Remppis A, Muller-Bardorff M, Katus HA. Cardiac troponin T in patients with end-stage renal disease: absence of expression in truncal skeletal muscle. Clin Chem 1998; 44: 930–938.

    PubMed  CAS  Google Scholar 

  17. McLaurin MD, Apple FS, Voss EM, Herzog CA, Sharkey SW. Cardiac troponin I, cardiac troponin T, and creatine kinase MB in dialysis patients without ischemic heart disease: evidence of cardiac troponin T expression in skeletal muscle. Clin Chem 1997; 43: 976–982.

    PubMed  CAS  Google Scholar 

  18. Adams J, Bodor G, Davila-Roman V, et al. Cardiac troponin I: a marker with high specificity for cardiac injury. Circulation 1993; 88: 101–106.

    Article  PubMed  Google Scholar 

  19. Trinquier S, Flecheux O, Bullenger M, Castex F. Highly specific immunoassay for cardiac troponin I assessed in noninfarct patients with chronic renal failure or severe polytrauma. Clin Chem 1995: 41: 1675–1676.

    PubMed  CAS  Google Scholar 

  20. Li D, halal I, Keffer J. Greater frequency of increased cardiac troponin T than increased cardiac troponin I in patients with chronic renal failure. Clin Chem 1996; 42: 114–115.

    PubMed  CAS  Google Scholar 

  21. Porter GA, Norton T, Bennett WB. Troponin T, a predictor of death in chronic haemodialysis patients. Eur Heart J 1998; 19 (Suppl): N34–37.

    PubMed  Google Scholar 

  22. Bhayana V, Gougoulias T, Cohee S. Discordance between results for serum troponin T and I in renal disease. Clin Chem 1995; 41: 312–317.

    PubMed  CAS  Google Scholar 

  23. Apple FS, Sharkey SW, Hoeft P, et al. Prognostic value of serum cardiac troponin I and T in chronic dialysis patients: a one year outcomes analysis. Am J Kidney Dis 1997; 29: 399–403.

    Article  PubMed  CAS  Google Scholar 

  24. Hafner G, Thome-Kromer B, Schaube J, Kupferwasser I, Ehrenthal W, Cummins P Cardiac troponins in serum in chronic renal failure. Clin Chem 1994; 40: 1790–1791.

    PubMed  CAS  Google Scholar 

  25. Ishii J, Ishikawa T, Yukitake J. Clinical specificity of a second generation cardiac troponin T assay in patients with chronic renal failure. Clin Chim Acta 1998; 270: 183–188.

    Article  PubMed  CAS  Google Scholar 

  26. Akagi M, Nagake Y, Makino H, Ota Z. A comparative study of myocardial troponin T levels in patients undergoing hemodialysis. Jpn J Nephrol 1995; 37: 639–643.

    CAS  Google Scholar 

  27. Frankel WL, Herold DA, Zregler TW, Fitzgerald RL. Cardiac troponin T is elevated in asymptomatic patients with chronic renal failure. Am J Clin Pathol 1996; 106: 118–123.

    PubMed  CAS  Google Scholar 

  28. Ooi DS, House AA. Cardiac troponin T in hemodialyzed patients. Clin Chem 1998; 44: 1410–1416.

    PubMed  CAS  Google Scholar 

  29. Bhayana V, Gougoulias T, Cohoe S, Henderson AR. Discordance between results for serum troponin T and troponin I in renal disease. Clin Chem 1995; 41: 312–317.

    PubMed  CAS  Google Scholar 

  30. Haller C, Stevanovich A, Katus HA. Are cardiac troponins reliable serodiagnostic markers of cardiac ischemia in end-stage renal disease? Nephrol Dial Transplant 1996; 11: 941–944.

    Article  PubMed  CAS  Google Scholar 

  31. Katus HA, Haller C, Müller-Bardorff M, Scheffold T, Remppis A. Cardiac troponin T in end-stage renal disease patients undergoing chronic maintenance hemodialysis. Clin Chem 1995; 41: 1201–1202.

    PubMed  CAS  Google Scholar 

  32. Haller C, Katus HA. Cardiac troponin T in dialysis patients. Clin Chem 1998; 44: 358.

    PubMed  CAS  Google Scholar 

  33. McNeil AR, Marshall M, Ellis CJ, Hawkins RC. Why is troponin T increased in the serum of patients with end-stage renal disease? Clin Chem 1998; 44: 2377–2378.

    PubMed  CAS  Google Scholar 

  34. Collinson PO, Stubbs PJ, Rosalki SB. Cardiac troponin T in renal disease. Clin Chem 1995; 41: 1671–1673.

    PubMed  CAS  Google Scholar 

  35. Lowbeer C, Deeberger AO, Gustafsson SA, Noilnian R, Hulting J, Gutierrez A. Increased cardiac T and endothelin-1 concentrations in dialysis patients may indicate heart disease. Nephrol Dial Transplant 1999; 14: 1948–1955.

    Article  PubMed  CAS  Google Scholar 

  36. Kinchi K, Nejima J, Takano T, Ohta M, Hashimoto H. Increased serum concentrations of advanced glycation end products: a marker of coronary artery disease activity in type 2 diabetic patients. Heart 2001; 85: 87–91.

    Article  Google Scholar 

  37. Ricchiuti V, Apple FS. Regulation of muscle gene and protein expression of creatine kinase B in chronic renal disease (abstract). Clin Chem 2000; 46: A90.

    Google Scholar 

  38. Diesel W, Emms M, Knight B, Noakes TD, Swanepoel CR, Smit R. Morphology features on the myopathy associated with chronic renal failure. Am J Kidney Dis 1993; 22: 677–684.

    PubMed  CAS  Google Scholar 

  39. McLaurin MD, Apple FS, Falahati A, Murakami M, Miller EA, Sharkey SW. Cardiac troponin I and creatine kinase MB mass to rule out myocardial injury in hospitalized patients with renal insufficiency. Am J Cardiol 1998; 82: 973–975.

    Article  PubMed  CAS  Google Scholar 

  40. Ottani F, Galvani M, Nicolini FA, Ferrini D, Pozzati A, DiPasquale G, Jaffe AS. Elevated cardiac troponin levels predict the risk of adverse outcome in patients with acute coronary syndromes. Am Heart J 2000; 40: 917–927.

    Article  Google Scholar 

  41. Heidenreich PA, Alloggiamento T, Melsop K, McDonald KM, Go AS, Hlatky MA. The prognostic value of troponin in patients with non-ST-elevation acute coronary syndromes: a meta-analysis. J Am Coll Cardiol 2001; 38: 478–488.

    Article  PubMed  CAS  Google Scholar 

  42. Roppolo LP, Fitzgerald R, Dillow J, Ziegler T, Rice M, Maisel A. A comparison of troponin T and troponin I as predictors of cardiac events in patients undergoing chronic dialysis at a Veteran’s hospital: a pilot study. J Am Coll Cardiol 1999; 34: 448–454.

    Article  PubMed  CAS  Google Scholar 

  43. VanLente F, McErlean ES, DeLuca SA, Rao JS, Nissen SE. Ability of troponins to predict adverse outcomes in patients with renal insufficiency and suspected acute coronary syndromes: a case matched study. J Am Coll Cardiol 1999; 33: 471–478.

    Article  CAS  Google Scholar 

  44. Porter GA, Norton T, Bennett WM. Long term follow-up of the utility of troponin T to assess cardiac risk in stable chronic hemodialysis patients. Clin Lab 2000; 46: 469–476.

    PubMed  CAS  Google Scholar 

  45. Dierkes J, Domrose U, Westphal S, et al. Cardiac troponin T predicts mortality in patients with end stage renal disease. Circulation 2000; 102: 1964–1969.

    Article  PubMed  CAS  Google Scholar 

  46. Ooi DS, Zimmerman D, Graham J, Wells GA. Cardiac troponin T predicts long-term outcomes in hemodialysis patients. Clin Chem 2001; 47: 412–417.

    PubMed  CAS  Google Scholar 

  47. 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: 2941–2945.

    Article  PubMed  CAS  Google Scholar 

  48. Apple FS, Wu AHB. Myocardial infarction redefined: role of cardiac troponin testing. Clin Chem 2001; 47: 377–379.

    PubMed  CAS  Google Scholar 

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Authors
  1. Fred S. Apple
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Editors and Affiliations

  1. Department of Pathology and Laboratory Medicine, Hartford Hospital, Hartford, CT, USA

    Alan H. B. Wu PhD

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© 2003 Springer Science+Business Media New York

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Apple, F.S. (2003). Cardiac Troponin Testing in Renal Failure and Skeletal Muscle Disease Patients. In: Wu, A.H.B. (eds) Cardiac Markers. Pathology and Laboratory Medicine. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-385-9_8

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  • DOI: https://doi.org/10.1007/978-1-59259-385-9_8

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-61737-319-0

  • Online ISBN: 978-1-59259-385-9

  • eBook Packages: Springer Book Archive

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