Clinical Cases: hs-TnT in Patients with End Stage Renal Failure
20 May 2021
In a subset of patients with end-stage renal disease (ESRD), the NACB guidelines 29 have recommended a change in the cTn concentration of ≥20% for the diagnosis of MI, in those who present with elevated cTn, 6–9 h after presentation, as indicative of a relevant concentration change because it represents a significant (3SD) change in cTn on the basis of a 5–7% analytical CV.1
In the present case, ESRD patient on dialysis with evidence of LVH and Chronic Heart disease is exhibiting non-specific chest pain symptoms. The serial measurement of troponin T in serum is useful to rule out AMI as there is no dynamic rise and or fall of its level within 48hrs.
Serial measurement of cTnT improves the diagnostic accuracy in patients with renal dysfunction.
Case 7
73-year-old male
Key signs and symptoms
Hypotension and short stabbing chest pain during dialysis, nausea
Medical history
Diabetes mellitus for 12 years, on dialysis for the past 2 years, hypertension for many years
Clinical examination
Third heart sound, BP 95/60mmHg, lungs normal, no edema; Normal ECG
Laboratory test results
Results
Reference range
CRP 3 mg/L
<5 mg/dL
Serum creatinine 7,5 mg/dL
<9 mg/dL
Hb 10,2 g/dL
Male: 13–18 g/dL /
Female: 12–16 g/dL
GFR 7 mL/min/1,73 m2
>90 mL/min/1,73 m2
ECG
Left ventricular hypertrophy with positive Sokolow index and discordant ST segment changes in the lateral chest leads.
The patient had experienced non-specific symptoms during dialysis. The ECG showed signs of left ventricular hypertrophy, while the coronary angiogram revealed a corkscrew-like tortuosity of the left circumflex artery accompanied by chronic hypertension. Given the high clinical likelihood of CHD, careful assessment is required. Furthermore, since elevated cTnT-hs levels would be expected in these patients, serial measurements are needed. According to the recommendation published by the NACB8, based on the use of less sensitive cTn generations (e.g. cTnT Gen 4), an increase of more than 20 % for a repeat measurement after 6 – 9 hours is indicative of an acute event.22
Conclusion
There is no rise or fall in cTnT-hs values needed for AMI diagnosis.
References
European Heart Journal (2011) 32, 404–411 doi:10.1093/eurheartj/ehq456
Prof Alexandre Mebazaa shares the key results and highlights from the STRONG-HF study that assessed the safety, tolerability of optimization of guideline directed medical therapy. [...]
Can you give us a short description of the CANVAS program? The CANVAS program was a set of two trials, whose goal was to evaluate the role of an SGLT2...
