Turk Kardiyol Dern Ars. 2008; 36(6): 382-387

Prognostic value of troponin T and homocysteine in patients with end-stage renal disease

Asife Şahinarslan¹, Galip Güz², Kaan Okyay¹, Rüya Mutluay², Rıdvan Yalçın¹, Musa Bali², Şükrü Sindel², Atiye Çengel^1
1Department of Cardiology, Medicine Faculty of Gazi University, Ankara
²Department of Nephrology, Medicine Faculty of Gazi University, Ankara

OBJECTIVES
The most important cause of increased mortality in end-stage renal disease (ESRD) is cardiovascular diseases. We investigated the prognostic value of cardiac troponin T (cTnT) and homocysteine in the long-term follow-up of ESRD patients.

STUDY DESIGN
The study included 78 patients (54 males, 24 females; mean age 53.2±16.6 years) with ESRD, who had been on hemodialysis treatment for at least three months. Baseline troponin T and homocysteine levels were measured and the patients were followed-up from March 2002 to May 2007 for major adverse cardiovascular events (MACE).

RESULTS
Major adverse cardiovascular events occurred in 26 patients (33.3%), including cerebrovascular events (n=3, 3.9%), congestive heart failure (CHF) (n=18, 23.1%), coronary artery disease (CAD) (n=19, 24.4%), and death (n=19, 24.4%). Two-thirds of diabetic patients developed MACE and the mean age in the MACE group was significantly greater (p<0.001). Troponin T levels were significantly higher in patients who developed MACE (0.21±0.43 ng/ml vs 0.06±0.28 ng/ml, p=0.002), whereas homocysteine levels did not differ significantly between the two groups (p=0.82). For a cutoff value of 0.10 ng/ml, cTnT was ≥0.1 ng/ml in 17 patients (21.8%), and <0.10 ng/ml in 61 patients (78.8%). Patients having a cTnT level of ≥0.10 ng/ml showed significantly higher rates of MACE (64.7% vs 24.6%; p=0.003), CHF (47.1% vs 16.4%; p=0.02), and death (52.9% vs 16.4%; p=0.004). There was also a greater tendency to CAD in this group (41.2% vs 19.7%, p=0.10). In multivariate logistic regression analysis, age and diabetes mellitus were the independent predictors of MACE development.

CONCLUSION
Homocysteine levels cannot predict MACE in ESRD patients in the long-term follow-up. Despite a significantly higher incidence of MACE in patients with high cTnT levels, cTnT was not an independent predictor of cardiovascular outcome.

Keywords: Biological markers/blood, cardiovascular diseases, homocysteine/blood; kidney failure, chronic/complications; renal dialysis; troponin T/blood.

---

CITE