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PEDIATRICS Vol. 112 No. 1 July 2003, pp. 79-86

Serum Cardiac Troponin and Subclinical Cardiac Status in Pediatric Chronic Renal Failure

Steven E. Lipshultz, MD*,#,{ddagger}{ddagger},§§, Michael J. G. Somers, MD{ddagger},#, Stuart R. Lipsitz, DSc,||, Steven D. Colan, MD*,#, Kathy Jabs, MD{ddagger},#,¶¶,|||| and Nader Rifai, PhD§,**

* Department of Cardiology
{ddagger} Division of Nephrology, Department of Medicine
§ Department of Laboratory Medicine, Children’s Hospital, Boston, Massachusetts
Division of Biostatistics, Dana Farber Cancer Institute, Boston, Massachusetts
|| Department of Biometry and Epidemiology, Medical University of South Carolina, Charleston, South Carolina
# Department of Pediatrics
** Department of Pathology, Harvard Medical School, Boston, Massachusetts
{ddagger}{ddagger} Division of Pediatric Cardiology, Golisano Children’s Hospital at Strong and University of Rochester Medical Center
§§ Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
¶¶ Division of Nephrology, Vanderbilt Children’s Hospital
|||| Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee

Background. Patients with uremia often have elevated serum cardiac troponin T (cTnT) even without clinical heart damage. Pediatric patients are ideal for studies of the relationship between uremia and heart disease because they are unlikely to have cardiac risk factors other than uremia.

Objective. To determine the relationship between uremia and cTnT levels.

Design. Echocardiograms and blood chemistry results were obtained from 50 pediatric patients with chronic renal failure and without clinical heart disease. Levels of cTnT were tested for correlation with cardiac dysfunction. In multivariate analysis, biochemical aspects of renal disease and its treatment were tested for correlation with cardiac dysfunction.

Results. Forty-nine patients had cardiovascular abnormalities, including increased left ventricular function and mass, elevated heart rate and blood pressure, and reduced LV afterload. LV contractility was inversely correlated with cTnT level (r = –0.36). Higher cTnT also correlated with higher serum creatine kinase-MB mass, lower serum parathyroid hormone, higher blood urea nitrogen and bicarbonate levels, and the use of diuretics, but not with higher cardiac troponin I. Left ventricular contractility was inversely related to serum creatinine, phosphorus, and the use of ß-blockers.

Conclusions. Elevated cTnT levels are not artifactual, but are genuine indicators of cardiomyocyte damage. Cardiac damage, indicated by either elevated cTnT or low LV contractility, is related to uremia, deranged calcium and phosphorus metabolism, and bicarbonate levels. Serum cTnT and LV contractility identify subclinical cardiac damage that could be treated to hopefully reduce cardiovascular morbidity and mortality in this high-risk population.

Key Words: chronic renal failure • hemodialysis • pediatrics • troponin • cardiomyopathy • myocardial dysfunction • child • uremia • chronic renal insufficiency

Abbreviations: CRF, chronic renal failure • CK-MB, serum creatine kinase-MB mass • cTnT, serum cardiac troponin T • GFR, glomerular filtration rate • CRI, chronic renal insufficiency • LV, left ventricular • BUN, blood urea nitrogen • PTH, parathyroid hormone • cTnI, serum cardiac troponin I

Received for publication Oct 29, 2001; Accepted Jan 6, 2003.




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