Diagnostic specificity and prognostic value of cardiac troponins in asymptomatic chronic haemodialysis patients: a three year prospective study.

Diagnosis and risk stratification of coronary artery disease (CAD) are key issues in the management of haemodialysis patients. In patients with end stage renal disease (ESRD), the specificity of cardiac troponin T (cTnT) is low (< 80%) in contrast to cardiac troponin I (cTnI) (81–100%). However, in asymptomatic patients with ESRD, an increased cTnT concentration is associated with an increased risk of acute coronary syndrome (ACS), and while some studies have documented the same relation between cTnI and future ACS others have been inconclusive or negative.1–4 Discrepancies between these studies may be secondary to the type of assay used to measure cTnI, the cut off concentration used to categorise patients, the outcome measured, or the length of patient follow up. Since cTnI are likely to be favoured over cTnT in the acute care of patients with ESRD because of a higher specificity, the predictive value of this marker in asymptomatic patients is important to clarify. Our work aimed at comparing the prognostic value of cardiac troponins over a three year follow up in asymptomatic patients with ESRD. A three year prospective study was undertaken in February 2001 of all eligible patients on chronic haemodialysis in our hospital. Patients having presented with angina within the previous 14 days or with a diagnosis of ACS in the previous four weeks were excluded. Other exclusion criteria were pericarditis, pulmonary embolism in the previous …