Elevated concentrations of cardiac troponin T are associated with thoracic aortic calcification in non-dialysis chronic kidney disease patients of stage G3 to G5
Creators: name: Zhu, Wenjiao
name: Lai, Zhiman
name: Xue, Miaorong
name: Feng, Shaozhen
name: Feng, Pinning
name: Pan, Xiantian
name: Ke, Xiaojie
name: Chen, Xionghui
name: Li, Zhijian
name: Mao, Haiping
name: Yang, Xiao
name: Huang, Fengxian
name: Chen, Wei
name: Xu, Yuanwen
name: Li, Shurong
name: Guo, Qunying
Publisher: name: Taylor & Francis
Year: 2024
Subjects: subject: Medicine
subject: Microbiology
subject: FOS: Biological sciences
subject: Cell Biology
subject: Physiology
subject: Immunology
subject: FOS: Clinical medicine
subject: Developmental Biology
subject: Hematology

description: Vascular calcification (VC), especially coronary artery calcification (CAC), serves as a robust predictor of cardiovascular mortality in chronic kidney disease (CKD) patients. Recent studies have revealed that the presence of extra-coronary calcifications (ECCs) contributes to cardiovascular disease (CVD). Elevated myocardial injury markers predict mortality risk in CKD patients and are associated with CVD. Nevertheless, the relationship between VC, including CAC and ECCs, and myocardial injury markers remain unexplored in non-dialysis CKD patients. In 278 non-dialysis CKD patients of stage G3 to G5, we assessed calcified scores in CAC (Agatston score) and ECCs including thoracic aortic calcification (TAC), abdominal aortic calcification (AAC), carotid artery calcification, and valvular calcification. We analyzed the relationships between VC and myocardial injury markers of cardiac troponin T (cTnT) and creatine kinase-MB (CK-MB). A total of 278 non-dialysis CKD patients (median age 52.4 ± 13.2; male 65.1%; diabetes 33.5%) were enrolled. A total of 71.8% (227) of patients had cTnT levels above the upper limit of normal (&gt; 0.014 ng/mL). Moderate to severe (calcified score ≥100 vs. &lt;100), CAC (OR 6.39; 95% CI 1.03–39.61) and TAC (OR 6.16; 95% CI 1.76–21.55) were significantly associated with higher cTnT concentrations after adjustment for confounders. Additionally, male sex and a lower eGFR were also associated with cTnT elevation. However, when we included CAC and TAC in one model, only moderate to severe TAC (OR 4.85; 95% CI 1.38–16.96) was a risk factor for cTnT elevation, but not CAC. Furthermore, patients with severer TAC presented lower diastolic blood pressure (DBP), wider pulse pressure (<i>p</i> &lt; 0.001) and higher prevalence of left ventricular hypertrophy (LVH). Moderate to severe thoracic aortic calcification (TAC score ≥ 100) is significantly associated with elevated cTnT concentrations in non-dialysis CKD patients of stage G3 to G5. The linkage may result from decreased coronary perfusion and relative myocardial ischemia. Vascular calcification (VC), including coronary artery calcification (CAC) and extra-coronary calcifications (ECCs), is recognized as a strong predictor of cardiovascular mortality in patients with chronic kidney disease (CKD). In this study involving 278 non-dialysis CKD patients of stage G3 to G5, we assessed the calcification scores for CAC, thoracic aortic calcification (TAC), abdominal aortic calcification (AAC), carotid artery calcification, and valvular calcification. And explored relationship between VC and myocardial injury markers such as cardiac troponin T (cTnT) and creatine kinase-MB (CK-MB). The study found that cTnT levels were associated with the severity of CAC (OR 6.39; 95% CI 1.03-39.61) and TAC (OR 6.16; 95% CI 1.76-21.55). After adjusting for confounding factors, only moderate to severe TAC (OR 4.85; 95% CI 1.38-16.96) was identified as a significant risk factor for elevated cTnT levels, but not CAC. Furthermore, the potential association between TAC and myocardial ischemia may be due to decreased coronary perfusion and left ventricular hypertrophy (LVH). These findings underscore the importance of monitoring TAC which may be more effectively associated with cardiovascular risks. <b>What was known:</b>VC is a common complication of CKD and and is associated with CVD death in CKD patients.cTnT levels are elevated in CKD patients, and the mechanism behind this elevation has not been thoroughly clarified. Furthermore, higher cTnT levels predict all-cause mortality in CKD patients.cTnT is independently associated with the degree of severity of CAC in asymptomatic hemodialysis patients. VC is a common complication of CKD and and is associated with CVD death in CKD patients. cTnT levels are elevated in CKD patients, and the mechanism behind this elevation has not been thoroughly clarified. Furthermore, higher cTnT levels predict all-cause mortality in CKD patients. cTnT is independently associated with the degree of severity of CAC in asymptomatic hemodialysis patients. <b>This study adds:</b>This study analyzed the relationship between myocardial injury biomarkers and CAC, as well as extra-coronary artery calcifications (ECCs) in non-dialysis CKD patients of stage G3 to G5.Moderate to severe TAC was also an independent risk factor for elevated cTnT concentrations. However, when we included CAC and TAC in one model, only TAC was independently associated with cTnT elevation but not CAC. This study analyzed the relationship between myocardial injury biomarkers and CAC, as well as extra-coronary artery calcifications (ECCs) in non-dialysis CKD patients of stage G3 to G5. Moderate to severe TAC was also an independent risk factor for elevated cTnT concentrations. However, when we included CAC and TAC in one model, only TAC was independently associated with cTnT elevation but not CAC. <b>Potential impacts:</b>In non-dialysis CKD patients of stage G3 to G5, elevated cTnT levels may be more likely to result from TAC than from CAC.TAC may contribute to cTnT elevation in non-dialysis CKD patients through decreased coronary perfusion (lower DBP and wider pulse pressure) and relative myocardial ischemia (LVH).Imaging markers of cardiovascular prognosis (VC) with clinical parameters (myocardial injury markers) may facilitate the identification of high-risk CVD populations among CKD patients more readily in the future. In non-dialysis CKD patients of stage G3 to G5, elevated cTnT levels may be more likely to result from TAC than from CAC. TAC may contribute to cTnT elevation in non-dialysis CKD patients through decreased coronary perfusion (lower DBP and wider pulse pressure) and relative myocardial ischemia (LVH). Imaging markers of cardiovascular prognosis (VC) with clinical parameters (myocardial injury markers) may facilitate the identification of high-risk CVD populations among CKD patients more readily in the future.