Risk stratification using serum concentrations of cardiac troponin T in patients with end-stage renal disease on chronic maintenance dialysis

Background: It has been recently suggested that cardiac troponin T (cTnT) may be more sensitive than troponin I (cTnl) for subclinical myocardial cell injury in patients on chronic dialysis. Methods: We prospectively compared the predictive value of cTnT with cTnI, atrial (ANP) and brain natriuretic peptide (BNP) in 100 consecutive outpatients on chronic dialysis without acute coronary syndromes over a period of 3 months, and assessed whether the combination of cTnT with clinical information including age, duration of dialysis, and medical histories was useful for risk stratification of these patients. During the 2-year follow-up period, 19 patients died, mostly due to cardiac causes (53%). Results: The area under the receiver operator characteristic (ROC) curve for the cTnT as predictor of both overall and cardiac death was significantly greater than the area under the cTnI curve ( p < 0.0001 and p = 0.01), the BNP curve ( p < 0.001 and p < 0.01) or the ANP curve (p < 0.0001 and p < 0.005). In a stepwise multivariate Cox regression analysis, only cTnT (p < 0.05 and p < 0.01) and a history of heart Failure requiring hospitalization ( p < 0.05 and p < 0.005) were independent predictors of both all cause and cardiac mortality. Using parameters of cTnT <greater than or equal to>0.1 mug/l and/or history of heart failure, the overall and cardiac mortality rate for the low risk group (n = 66) were 4.5% and 1.5%, respectively, 40% and 16% for the intermediate risk group (n = 25), and 67% and 56% for the high risk group (n = 9). Conclusion: cTnT concentrations offer a higher prognostic accuracy than cTnI, ANP and BNP in patients on chronic dialysis. The combination of elevated cTnT and a history of heart failure may be a highly effective means of risk stratification of these patients. (C) 2001 Elsevier Science B.V. All rights reserved.