Supplementary Material for: Clinical Significance of Increased Cardiac Troponin T in Patients with Chronic Hemodialysis and Cardiovascular Disease: Comparison to B-Type Natriuretic Peptide and A-Type Natriuretic Peptide Increase

<b><i>Background:</i></b> An increased cardiac troponin T (cTnT) level identifies a high-risk group in patients with end-stage renal disease; however, the mechanism of cTnT elevation remains unclear in such patients without acute coronary syndrome (ACS). Therefore, we explored the relationship between cTnT levels and the hemodynamic parameters and the prognostic potential of cTnT in stable patients with chronic hemodialysis (HD). <b><i>Methods:</i></b> We included consecutive 174 patients with HD who were referred for coronary angiography due to stable coronary artery disease (CAD), peripheral artery disease (PAD), or heart failure (HF). Hemodynamic measurement was performed, and plasma cTnT, B-type natriuretic peptide (BNP), and A-type natriuretic peptide (ANP) were measured at the same time. The potential of 3 biomarkers to predict all-cause mortality, cardiac death or hospitalized HF, and vascular event was assessed. <b><i>Results:</i></b> Increased log cTnT levels were correlated with increased log BNP and log ANP levels (<i>r</i> = 0.531, <i>p</i> &lt; 0.001 and <i>r</i> = 0.411, <i>p</i> &lt; 0.001, respectively). Not increased log cTnT, but increased log BNP and log ANP were associated with the presence of CAD and the extent of CAD. In contrast, they were all associated with the New York Heart Association functional classification and the presence of PAD and significantly correlated with left ventricular end-diastolic pressure (LVEDP) in an independent manner. Increased cTnT and BNP levels were associated with the mortality and hospitalized HF. However, increased cTnT was not associated with vascular events, unlike increased BNP. <b><i>Conclusions:</i></b> In patients with chronic HD without ACS, increased cTnT reflected increased LVEDP and the presence of HF or PAD independently, and it did not reflect the presence of CAD in contrast to increased BNP. cTnT and BNP were significant prognostic predictors; however, increased cTnT was associated with HF-related events, not with arteriosclerotic events.

<b><i>背景：</i></b> 心肌肌钙蛋白T（cardiac troponin T，cTnT）水平升高可识别终末期肾病患者中的高危人群，但此类无急性冠状动脉综合征（acute coronary syndrome，ACS）患者的cTnT升高机制仍不明确。为此，本研究探讨了稳定期慢性血液透析（hemodialysis，HD）患者的cTnT水平与血流动力学参数的关联，以及cTnT的预后价值。
<b><i>方法：</i></b> 本研究纳入了因稳定型冠状动脉疾病（coronary artery disease，CAD）、外周动脉疾病（peripheral artery disease，PAD）或心力衰竭（heart failure，HF）而接受冠状动脉造影的连续174例慢性血液透析患者。同期开展血流动力学检测，并同步测定血浆cTnT、B型利钠肽（B-type natriuretic peptide，BNP）及A型利钠肽（A-type natriuretic peptide，ANP）水平。评估了3种生物标志物预测全因死亡率、心源性死亡或因心力衰竭住院、血管事件的效能。
<b><i>结果：</i></b> 对数转换后的cTnT水平升高与对数转换后的BNP、ANP水平升高呈显著正相关（相关系数r=0.531，P<0.001；r=0.411，P<0.001）。对数转换后的cTnT水平升高与冠状动脉疾病的存在及病变程度无关联，而对数转换后的BNP、ANP水平升高则与此相关。与之相反，cTnT与BNP水平升高均与纽约心脏协会功能分级、外周动脉疾病的存在显著相关，且可独立反映左心室舒张末期压（left ventricular end-diastolic pressure，LVEDP）的变化。cTnT及BNP水平升高与死亡率及因心力衰竭住院事件相关。但与BNP升高不同的是，cTnT升高与血管事件无显著关联。
<b><i>结论：</i></b> 在无急性冠状动脉综合征的慢性血液透析患者中，cTnT水平升高可独立反映左心室舒张末期压升高及心力衰竭或外周动脉疾病的存在，且与冠状动脉疾病的存在无关，这与BNP升高的临床意义不同。cTnT与BNP均为重要的预后预测因子，但cTnT升高仅与心力衰竭相关事件相关，而非动脉粥样硬化性血管事件。