Sensitive Troponins – Which Suits Better for Hemodialysis Patients Associated Factors and Prediction of Mortality 英文参考文献.docVIP

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Sensitive Troponins – Which Suits Better for Hemodialysis Patients Associated Factors and Prediction of Mortality 英文参考文献.doc

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Sensitive Troponins – Which Suits Better for Hemodialysis Patients Associated Factors and Prediction of Mortality 英文参考文献

SensitiveTroponins–WhichSuitsBetterfor HemodialysisPatients?AssociatedFactorsand PredictionofMortality FerruhArtunc1*,ChristianMueller2,TobiasBreidthardt2,RaphaelTwerenbold2,AndreasPeter1, ClausThamer1,PeterWeyrich1,Hans-UlrichHaering1,BjoernFriedrich1,3 1Department of Internal Medicine, Division of Endocrinology, Diabetology, Vascular Disease, Nephrology and Clinical Chemistry, University of Tuebingen, Germany, 2DepartmentofInternalMedicine,DivisionofCardiology,UniversityofBasel,Basel,Switzerland,3DialysisCenter,Leonberg,Germany Abstract Background: In hemodialysis patients, elevated plasma troponin concentrations are a common finding that has even increased with the advent of newly developed sensitive assays. However, the interpretation and relevance of this is still underdebate. Methods:Inthiscross-sectionalstudy,weanalyzedplasmaconcentrationsofsensitivetroponinI(TnI)andtroponinT(TnT) instableambulatoryhemodialysispatients(n=239)andinvestigatedtheirassociationswithclinicalfactorsandmortality. Results: In all of the enrolled patients, plasma TnI or TnT was detectable at a median concentration of 14pg/ml (interquartilerange:7–29)usingtheSiemensTnIultraassayand49pg/ml(31–74)usingtheRocheElecsyshighsensitive TnT assay. Markedly more patients exceeded the 99th percentile for TnT than for TnI (95% vs. 14%, p,0.0001). In a multivariate linear regression model, TnT was independently associated with age, gender, systolic dysfunction, time on dialysis, residual diuresis and systolic blood pressure, whereas TnI was independently associated with age, systolic dysfunction,pulsepressure,timeondialysisanddurationofaHDsession.Duringafollow-upperiodofnearlytwoyears, TnT concentration above 38pg/mL was associated with a 5-fold risk of death, whereas elevation of TnI had a gradual associationtomortality. Conclusion:Inhemodialysispatients,elevationsofplasmatroponinconcentrationsareexplainedbycardiacfunctionand dialysis-relatedparameters,whichcontributetocardiacstrain.Botharehighly