MO744HIGH SENSIVITY CARDIAC TROPONIN I, A POSSIBLE BIOMARKER OF DIASTOLIC DYSFUNCTION IN ASYMPTOMATIC PATIENTS IN HEMODIALYSIS
Authors: Castro Fernández Maria Paz , Piccone Saponara Luis Guillermo , Moral Berrio Esperanza , Ferrer García Guillermo , García Conejo Gloria , Carreño Parrilla Agustín , Olazo Gutierrez Eliana , Ugarte Camara Marina , Sanchez Escudero Patricia , Vozmediano Poyatos Carmen 
Published: May 2021

Abstract

Background and Aims
Impairment in the diastolic function is strongly associated with heart failure and cardiovascular disease in patients with end-stage renal disease (ESRD), with a high prevalence of 50-65% and unobvious early symptoms. Hence, it is of great importance to explore serum biomarkers for early assessment of diastolic disfunction in patients with ESRD, providing evidence for performing an early intervention. When myocardial cell membrane integrity becomes damaged, cardiac troponin is released into the circulation, inducing an elevation of serum cardiac troponin in asymptomatic patients on dialysis. We analyzed the relationship between high-sensitivity cardiac troponin I biomarker (hs-cTnI) and left ventricular diastolic dysfunction (LVDD) in a cohort of asymptomatic patients on haemodialysis at our center.

Method
Cross-sectional study. We include patients on haemodialysis in our center. Demographic variables (age, sex), associated comorbidity, hs-cTnI levels, and echocardiographic parameters were collected. Statistical analysis was performed with SPSS 25.0. Categorical variables are expressed as percentages and compared using Chi2 test. Quantitative variables are expressed as mean ± standard deviation, and T-student, Anova or U-mann Whitney was used to compare them. Logistic regression analysis was performed to determine independent predictors of LVDD. Statistical significance for a value of p &lt;0.05.

Results
80 patients, with an average age of 67.44 ± 13 years. 57.5% were men. 86.3% had high blood pressure (HBP), 52.5% were diabetic, 75% dyslipidemic, and 51.2% had overweight/obese body mass index. 32.5% had previous history of ischemic heart disease, 41.3% had moderate/severe left ventricle hypertrophy (LVH), 8.8% left ventricular ejection fraction (LVEF) &lt;55% and 37.5% LVDD. Mean hs-cTnI was 31.27 ± 59.37 ng/L. LVDD was related to age (71 ± 10 years vs 65 ± 14 years p = 0.049), HBP (96.7% vs 3.3% p = 0.036), moderate/severe LVH (63.3% vs 36.7% p = 0.002), heart rate (HR) (66.96 ± 8.6 vs 77.28 ± 43.63 p = 0.036) and hs-cTnI (47.48 ± 81.97 ng/L vs 21.54 ± 38.06 ng/L p = 0.005). We divide the hs-cTnI into quartiles, with mean hs-cTnI levels 4.83 ± 1.92 ng/L in Q1, 9.86 ± 1.68 ng/L in Q2, 20.67 ± 4.26 ng L in Q3 and 89.73 ± 98.49 ng/L in Q4. We observed statistical significance for age (Q3 71 ± 10 ng/L vs 60 ± 17 ng/L p = 0.040), HBP (Q4 141.60 ± 16.68 ng/L vs Q1 123.90 ± 25, 98 ng/L p = 0.025), overweight/obesity (p = 0.001) and LVEF &lt;55% (p = 0.015). The logistic regression showed that HR (OR 0.94 95% CI 0.89-0.99 p = 0.025), LVH severity (OR 5.16 95% CI 1.74-15.25 p = 0.003), and hs-cTnI &gt; 20 (OR 4.11 95% CI 1.38-12.18 p = 0.011) are independent risk factors for LVDD.

Conclusion
hs-cTnI levels could be a biomarker of LVDD in asymptomatic patients on haemodialysis. New studies with a greater number of patients would increase the evidence for this claim, in order to carry out early intervention and treatment.