Serum cardiac troponin and subclinical cardiac status in pediatric chronic renal failure

Steven E Lipshultz, Michael J G Somers, Stuart R. Lipsitz, Steven D. Colan, Kathy Jabs, Nader Rifai

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Background. Patients with uremia often have elevated serum cardiac troponin T (cTnT) even without clinical heart damage. Pediatric patients are ideal for studies of the relationship between uremia and heart disease because they are unlikely to have cardiac risk factors other than uremia. Objective. To determine the relationship between uremia and cTnT levels. Design. Echocardiograms and blood chemistry results were obtained from 50 pediatric patients with chronic renal failure and without clinical heart disease. Levels of cTnT were tested for correlation with cardiac dysfunction. In multivariate analysis, biochemical aspects of renal disease and its treatment were tested for correlation with cardiac dysfunction. Results. Forty-nine patients had cardiovascular abnormalities, including increased left ventricular function and mass, elevated heart rate and blood pressure, and reduced LV afterload. LV contractility was inversely correlated with cTnT level (r = -0.36). Higher cTnT also correlated with higher serum creatine kinase-MB mass, lower serum parathyroid hormone, higher blood urea nitrogen and bicarbonate levels, and the use of diuretics, but not with higher cardiac troponin I. Left ventricular contractility was inversely related to serum creatinine, phosphorus, and the use of β-blockers. Conclusions. Elevated cTnT levels are not artifactual, but are genuine indicators of cardiomyocyte damage. Cardiac damage, indicated by either elevated cTnT or low LV contractility, is related to uremia, deranged calcium and phosphorus metabolism, and bicarbonate levels. Serum cTnT and LV contractility identify subclinical cardiac damage that could be treated to hopefully reduce cardiovascular morbidity and mortality in this high-risk population.

Original languageEnglish
Pages (from-to)79-86
Number of pages8
JournalPediatrics
Volume112
Issue number1 I
DOIs
StatePublished - Jul 1 2003
Externally publishedYes

Fingerprint

Troponin T
Troponin
Chronic Kidney Failure
Uremia
Pediatrics
Serum
Bicarbonates
Phosphorus
Heart Diseases
Cardiovascular Abnormalities
MB Form Creatine Kinase
Troponin I
Blood Urea Nitrogen
Parathyroid Hormone
Left Ventricular Function
Diuretics
Cardiac Myocytes
Creatinine
Multivariate Analysis
Heart Rate

Keywords

  • Cardiomyopathy
  • Child
  • Chronic renal failure
  • Chronic renal insufficiency
  • Hemodialysis
  • Myocardial dysfunction
  • Pediatrics
  • Troponin
  • Uremia

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Lipshultz, S. E., Somers, M. J. G., Lipsitz, S. R., Colan, S. D., Jabs, K., & Rifai, N. (2003). Serum cardiac troponin and subclinical cardiac status in pediatric chronic renal failure. Pediatrics, 112(1 I), 79-86. https://doi.org/10.1542/peds.112.1.79

Serum cardiac troponin and subclinical cardiac status in pediatric chronic renal failure. / Lipshultz, Steven E; Somers, Michael J G; Lipsitz, Stuart R.; Colan, Steven D.; Jabs, Kathy; Rifai, Nader.

In: Pediatrics, Vol. 112, No. 1 I, 01.07.2003, p. 79-86.

Research output: Contribution to journalArticle

Lipshultz, SE, Somers, MJG, Lipsitz, SR, Colan, SD, Jabs, K & Rifai, N 2003, 'Serum cardiac troponin and subclinical cardiac status in pediatric chronic renal failure', Pediatrics, vol. 112, no. 1 I, pp. 79-86. https://doi.org/10.1542/peds.112.1.79
Lipshultz SE, Somers MJG, Lipsitz SR, Colan SD, Jabs K, Rifai N. Serum cardiac troponin and subclinical cardiac status in pediatric chronic renal failure. Pediatrics. 2003 Jul 1;112(1 I):79-86. https://doi.org/10.1542/peds.112.1.79
Lipshultz, Steven E ; Somers, Michael J G ; Lipsitz, Stuart R. ; Colan, Steven D. ; Jabs, Kathy ; Rifai, Nader. / Serum cardiac troponin and subclinical cardiac status in pediatric chronic renal failure. In: Pediatrics. 2003 ; Vol. 112, No. 1 I. pp. 79-86.
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abstract = "Background. Patients with uremia often have elevated serum cardiac troponin T (cTnT) even without clinical heart damage. Pediatric patients are ideal for studies of the relationship between uremia and heart disease because they are unlikely to have cardiac risk factors other than uremia. Objective. To determine the relationship between uremia and cTnT levels. Design. Echocardiograms and blood chemistry results were obtained from 50 pediatric patients with chronic renal failure and without clinical heart disease. Levels of cTnT were tested for correlation with cardiac dysfunction. In multivariate analysis, biochemical aspects of renal disease and its treatment were tested for correlation with cardiac dysfunction. Results. Forty-nine patients had cardiovascular abnormalities, including increased left ventricular function and mass, elevated heart rate and blood pressure, and reduced LV afterload. LV contractility was inversely correlated with cTnT level (r = -0.36). Higher cTnT also correlated with higher serum creatine kinase-MB mass, lower serum parathyroid hormone, higher blood urea nitrogen and bicarbonate levels, and the use of diuretics, but not with higher cardiac troponin I. Left ventricular contractility was inversely related to serum creatinine, phosphorus, and the use of β-blockers. Conclusions. Elevated cTnT levels are not artifactual, but are genuine indicators of cardiomyocyte damage. Cardiac damage, indicated by either elevated cTnT or low LV contractility, is related to uremia, deranged calcium and phosphorus metabolism, and bicarbonate levels. Serum cTnT and LV contractility identify subclinical cardiac damage that could be treated to hopefully reduce cardiovascular morbidity and mortality in this high-risk population.",
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N2 - Background. Patients with uremia often have elevated serum cardiac troponin T (cTnT) even without clinical heart damage. Pediatric patients are ideal for studies of the relationship between uremia and heart disease because they are unlikely to have cardiac risk factors other than uremia. Objective. To determine the relationship between uremia and cTnT levels. Design. Echocardiograms and blood chemistry results were obtained from 50 pediatric patients with chronic renal failure and without clinical heart disease. Levels of cTnT were tested for correlation with cardiac dysfunction. In multivariate analysis, biochemical aspects of renal disease and its treatment were tested for correlation with cardiac dysfunction. Results. Forty-nine patients had cardiovascular abnormalities, including increased left ventricular function and mass, elevated heart rate and blood pressure, and reduced LV afterload. LV contractility was inversely correlated with cTnT level (r = -0.36). Higher cTnT also correlated with higher serum creatine kinase-MB mass, lower serum parathyroid hormone, higher blood urea nitrogen and bicarbonate levels, and the use of diuretics, but not with higher cardiac troponin I. Left ventricular contractility was inversely related to serum creatinine, phosphorus, and the use of β-blockers. Conclusions. Elevated cTnT levels are not artifactual, but are genuine indicators of cardiomyocyte damage. Cardiac damage, indicated by either elevated cTnT or low LV contractility, is related to uremia, deranged calcium and phosphorus metabolism, and bicarbonate levels. Serum cTnT and LV contractility identify subclinical cardiac damage that could be treated to hopefully reduce cardiovascular morbidity and mortality in this high-risk population.

AB - Background. Patients with uremia often have elevated serum cardiac troponin T (cTnT) even without clinical heart damage. Pediatric patients are ideal for studies of the relationship between uremia and heart disease because they are unlikely to have cardiac risk factors other than uremia. Objective. To determine the relationship between uremia and cTnT levels. Design. Echocardiograms and blood chemistry results were obtained from 50 pediatric patients with chronic renal failure and without clinical heart disease. Levels of cTnT were tested for correlation with cardiac dysfunction. In multivariate analysis, biochemical aspects of renal disease and its treatment were tested for correlation with cardiac dysfunction. Results. Forty-nine patients had cardiovascular abnormalities, including increased left ventricular function and mass, elevated heart rate and blood pressure, and reduced LV afterload. LV contractility was inversely correlated with cTnT level (r = -0.36). Higher cTnT also correlated with higher serum creatine kinase-MB mass, lower serum parathyroid hormone, higher blood urea nitrogen and bicarbonate levels, and the use of diuretics, but not with higher cardiac troponin I. Left ventricular contractility was inversely related to serum creatinine, phosphorus, and the use of β-blockers. Conclusions. Elevated cTnT levels are not artifactual, but are genuine indicators of cardiomyocyte damage. Cardiac damage, indicated by either elevated cTnT or low LV contractility, is related to uremia, deranged calcium and phosphorus metabolism, and bicarbonate levels. Serum cTnT and LV contractility identify subclinical cardiac damage that could be treated to hopefully reduce cardiovascular morbidity and mortality in this high-risk population.

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