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Troponin T Identifies Renal Patients at High Mortality Risk
Clinical study confirms Troponin T as the most sensitive
marker for risk stratification
Basel, Switzerland - December 19, 2002 - More than 0.5 million patients
world-wide are affected by end-stage renal disease and are on long-term
dialysis. Cardiac disease is the most important cause of death in
these patients accounting for more than 50% of deaths. Only early
detection and a more aggressive treatment are likely to decrease
the high mortality rate among these patients with end-stage renal
disease.
The outcome of a clinical study now confirmed the significance
of the use of troponin T for risk stratification of patients with
renal failure independent on any symptoms or history of coronary
heart disease. With this study the diagnostic tool for the detection
of high-risk patients has been established: Elecsys® Troponin
T.
Cardiac troponin T (and troponin I) are intracellular components
of the contractile apparatus of the heart muscle. Already in 1989,
Hugo Katus and co-workers reported that cardiac troponin T levels
are increased within patients with acute myocardial infarction1.
In the following years, many clinical studies confirmed that troponin
T is a specific and very sensitive marker for the diagnosis of myocardial
infarction. Beside the diagnostic value, troponins have also a very
powerful prognostic value in predicting the outcome of patients
presenting with symptoms of unstable angina. As a consequence, the
societies of Cardiology in Europe and US defined the troponins as
the biochemical gold standard for the new definition of myocardial
infarction2
and included them in the guidelines for diagnostic and therapeutic
decision algorithms3.
Troponin T is also elevated in approx. 30% of patients with renal
disease without clear evidence of overt cardiac injury. During the
last few years, evidence has been accumulating that troponin T is
a predictor of death in these patients.
Fred Apple, University of Minnesota School of Medicine, Minneapolis/US,
performed a study in 733 end-stage renal patients which represents
a landmark in supporting the clinical role of troponin T in this
clinical indication4. Patients with an increased
troponin T level showed an up to 5- fold increase of mortality.
This prognostic value persisted over the 3 years observation period.
This study also confirms previous observations in renal patients
that troponin T is superior to troponin I as a predictor of death
in those patients5,6.
"Elecsys® Troponin T meets the need of the recognition
of hemodialysis patients who are at high risk to die within the
following months or years and therewith provides a unique and unparalleled
information. This will help in the future to improve patient care
by early detection and targeted aggressive treatment" says
Manfred Baier, Head of Business Area Lab Network at Roche Diagnostics.
Henceforth not only cardiologists will use troponin T for risk
stratification and therapy decision making but also nephrologists
for risk assessment in end-stage renal patients independent on any
symptoms or history of coronary heart disease. Although the therapeutic
consequences have to be determined, the diagnostic tool is now established.
1 Katus HA et al. J Mol Cell Cardiol 1989; 21:1349
2 Alpert JS and Thygesen K. J Am Col Cardiol 2000; 36:959-969
3 Braunwald E et al. Circulation 2000; 102:1193-1209.
4 FS Apple et al. Circulation 2002; 106:2941
5 CW Hamm et al. Circulation 2002; 106:2871, editorial
6 Ishii J. et al. Clin Chim Acta 2001, 312:69
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of diseases, thus enhancing people's health and quality of life.
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please visit our websites www.roche.com
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