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. 2019 Sep 17;8(18):e013357.
doi: 10.1161/JAHA.119.013357. Epub 2019 Sep 13.

Association Between High-Sensitivity Cardiac Troponin T and Echocardiographic Parameters in Chronic Kidney Disease: Results From the KNOW-CKD Cohort Study

Eunjeong Kang  1 , Hyunjin Ryu  1 , Jayoun Kim  2 , Joongyub Lee  3 , Kyu-Beck Lee  4 , Dong-Wan Chae  5 , Su Ah Sung  6 , Soo Wan Kim  7 , Curie Ahn  1 , Kook-Hwan Oh  1
Affiliations

Association Between High-Sensitivity Cardiac Troponin T and Echocardiographic Parameters in Chronic Kidney Disease: Results From the KNOW-CKD Cohort Study

Eunjeong Kang et al. J Am Heart Assoc. .

Abstract

Background It is unclear whether high-sensitivity troponin T (hs-TnT) is associated with subclinical cardiac changes in chronic kidney disease (CKD). We evaluated the relationship between hs-TnT and left ventricular structure and function in a CKD population, according to estimated glomerular filtration rate. Methods and Results We analyzed 2017 patients with CKD stages 1 to 5 (predialysis) in the KNOW-CKD (Korean Cohort Study for Outcome in Patients With Chronic Kidney Disease) cohort. The predictor was hs-TnT level measured at baseline, and the outcomes were left ventricular hypertrophy (LVH) and systolic and diastolic dysfunction shown by echocardiography at baseline and after 4 years. Participants were categorized into quartiles according to hs-TnT levels. The associations between quartiles of hs-TnT and outcomes were assessed using multivariable logistic regression analysis with confounders including demographics, medical history, and laboratory findings. A receiver operating characteristic curve was used to assess the diagnostic power of hs-TnT for the outcomes as a continuous variable. For subgroup analysis, patients were stratified based on an estimated glomerular filtration rate of 60 mL/min per 1.73 m2. Elevated hs-TnT was associated with LVH and diastolic dysfunction at baseline in an adjusted model but was not associated with systolic dysfunction. These associations remained significant for both estimated glomerular filtration rate subgroups. Receiver operating characteristic curve analysis showed that hs-TnT as a continuous variable exhibited fair significance for detection of LVH (area under the curve: 0.689) and diastolic dysfunction (area under the curve: 0.744). Multivariable analysis showed that higher hs-TnT levels at baseline were related to development of LVH but not diastolic dysfunction (n=864). Conclusions In CKD patients, hs-TnT is strongly associated with alterations of left ventricular structure and diastolic dysfunction for both estimated glomerular filtration rate strata. Baseline hs-TnT levels are predictive of new LVH on follow-up.

Keywords: chronic kidney disease; diastolic dysfunction; left ventricular hypertrophy; troponin T.

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Figures

Figure 1
Figure 1
Study flow. hs‐TnT indicates high‐sensitivity cardiac troponin T (TnT); KNOW‐CKD, Korean Cohort Study for Outcomes in Patients With Chronic Kidney Disease; LVMI, left ventricular mass index.
Figure 2
Figure 2
Elevated hs‐TnT levels are associated with LVH in patients with chronic kidney disease. With increasing quartiles of hs‐TnT, the prevalence of concentric and eccentric LVH and concentric remodeling increases. hs‐TnT indicates high‐sensitivity cardiac troponin T; LVH, left ventricular hypertrophy;
Figure 3
Figure 3
Association between hs‐TnT and left ventricular structure and function at baseline echocardiography. A, Left ventricular hypertrophy: adjusted for age, sex, mean arterial pressure, DM, hypertension, coronary artery disease, CKD stage, mean arterial pressure, BMI, HDL (high‐density lipoprotein), triglyceride, hemoglobin. B, Systolic dysfunction: adjusted for age, sex, coronary artery disease, CKD stage. C, Diastolic dysfunction: adjusted for age, sex, DM, hypertension, CKD stage, BMI, HDL, triglyceride, CRP (C‐reactive protein), smoking history. BMI indicates body mass index; CKD, chronic kidney disease; DM, diabetes mellitus; hs‐TnT, high‐sensitivity troponin T. * indicates P<0.05.
Figure 4
Figure 4
The association between hs‐TnT and follow‐up echocardiography. A, New LVH: adjusted for age, sex, mean arterial pressure, DM, hypertension, coronary artery disease, CKD stage, BMI, HDL (high‐density lipoprotein), triglyceride, hemoglobin. B, New diastolic dysfunction: adjusted to age, sex, DM, hypertension, CKD stage, BMI, HDL, triglyceride, CRP (C‐reactive protein), smoking history. BMI indicates body mass index; CKD, chronic kidney disease; DM, diabetes mellitus; hs‐TnT, high‐sensitivity troponin T; LVH, left ventricular hypertrophy. * indicates P<0.05.
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