Serial high-sensitivity cardiac troponin I trajectories predict cardiovascular events in hemodialysis patients

TL;DR

Tracking changes in a heart protein over time can help predict heart problems in patients on dialysis.

Contribution

Serial high-sensitivity cardiac troponin I measurements independently predict cardiovascular risk in hemodialysis patients.

Findings

A 2.06-fold increased risk of MACE was found in patients with high baseline hs-cTnI.

Each 10 ng/L increase in time-updated hs-cTnI was linked to a 2.71% higher MACE risk.

Patients with MACE had higher hs-cTnI levels and steeper increases over time.

Abstract

Although commonly elevated in maintenance hemodialysis (MHD) patients without apparent myocardial ischemia, the prognostic significance of serial high-sensitivity cardiac troponin I (hs-cTnI) changes remains underexplored. We aimed to evaluate the association between longitudinal hs-cTnI trajectories and cardiovascular events in MHD patients.

This retrospective cohort study enrolled 265 clinically stable MHD patients with repeated hs-cTnI measurements (mean six per patient) and followed them until the first major adverse cardiovascular event (MACE) or January 2024. Nonlinear relationships were analyzed using restricted cubic splines, with inflection points identified to assess threshold and saturation effects. Multivariate regression analyses, time-dependent Cox and splines for time were used to investigate the association of hs-cTnI with MACE using single time point (at baseline) and repeated measurements, respectively.

Among 265 MHD patients, the incidence of MACE was 41.9%. Nonlinear relationships between hs-cTnI and MACE were identified, with an inflection point at 64 ng/L. Multiple regression equations showed a 2.06-fold increased risk of MACE in the high baseline hs-cTnI group compared with the low baseline hs-cTnI group after adjusting for numerous influencing factors. After full adjustment, each 10 ng/L increase in the time-updated hs-cTnI value remained significantly associated with a 2.71% elevated risk of MACE. Splines for time demonstrated that patients with MACE exhibited higher hs-cTnI concentrations and steeper trajectories compared with those without MACE.

Serial hs-cTnI changes independently predict cardiovascular risk in MHD patients, suggesting that dynamic measurement of hs-cTnI may be useful for monitoring cardiovascular prognosis and early intervention in this high-risk population.

GRAPHICAL ABSTRACT

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