Association of Subtle Left Ventricular Systolic Dysfunction with Elevated Cardiac Troponin T in Asymptomatic Hemodialysis Patients with Preserved Left Ventricular Ejection Fraction

Abstract

Background: Increased cardiac troponin T (cTnT) concentrations are associated with a poor prognosis in end-stage renal disease (ESRD) patients. However, the impact of increased cTnT levels on left ventricular (LV) function is not well understood. Therefore, our study focused on LV function in asymptomatic hemodialysis patients with preserved left ventricular ejection fraction (LVEF) and elevated cTnT levels. Methods: Asymptomatic ESRD patients undergoing maintenance hemodialysis, with LVEF 50%, underwent echocardiographic examination and further testing to determine serum cTnT, high-sensitivity C-reactive protein (hsCRP) and albumin levels. Subjects were then stratified into one of two groups based on the cTnT level, with a cutoff value of 0.04 ng/mL. Results: There were no significant differences in gender, age, LVEF, systolic myocardial velocity, and the prevalence of comorbidities (except diabetes mellitus) between these two groups. Patients in the high cTnT group (>= 0.04 ng/mL) presented with higher hsCRP levels than patients in the low cTnT group (1.50 +/- 0.35 mg/dL vs. 0.59 +/- 0.62 mg/dL, p = 0.02). Additionally, reduced global LV peak systolic longitudinal strain (GLS) developed in the high cTnT group compared with the low group (-17.1 +/- 3.7% vs. -19.4 +/- 3.5%, p = 0.004). The deteriorated GLS was an independent factor correlated with higher cTnT levels in asymptomatic hemodialysis patients with preserved LVEF (p = 0.013, 95% CI = 0.71-0.96). Conclusion: Patients in the high cTnT group presented with higher levels of hsCRP and more reduced GLS than those in the low cTnT group, and reduced GLS was the independent factor of elevated cTnT level. Consequently, we concluded that those asymptomatic hemodialysis patients with elevated cTnT concentrations had LV systolic dysfunction.