1.A More Appropriate Cardiac Troponin T Level That Can Predict Outcomes in End-Stage Renal Disease Patients with Acute Coronary Syndrome.
Dong Ryeol RYU ; Jung Tak PARK ; Jung Hwa CHUNG ; Eun Mi SONG ; Sun Hee ROH ; Jeong Min LEE ; Hye Rim AN ; Mina YU ; Wook Bum PYUN ; Gil Ja SHIN ; Seung Jung KIM ; Duk Hee KANG ; Kyu Bok CHOI
Yonsei Medical Journal 2011;52(4):595-602
PURPOSE: Cardiac troponin T (cTnT), a useful marker for diagnosing acute myocardial infarction (AMI) in the general population, is significantly higher than the usual cut-off value in many end-stage renal disease (ESRD) patients without clinically apparent evidence of AMI. The aim of this study was to evaluate the clinical usefulness of cTnT in ESRD patients with acute coronary syndrome (ACS). MATERIALS AND METHODS: Two hundred eighty-four ESRD patients with ACS were enrolled between March 2002 and February 2008. These patients were followed until death or June 2009. Medical records were reviewed retrospectively. The cut-off value of cTnT for AMI was evaluated using a receiver operating characteristic (ROC) curve. We calculated Kaplan-Meier survival curves, and potential outcome predictors were determined by Cox proportional hazard analysis. RESULTS: AMIs were diagnosed in 40 patients (14.1%). The area under the curve was 0.98 in the ROC curve (p<0.001; 95% CI, 0.95-1.00). The summation of sensitivity and specificity was highest at the initial cTnT value of 0.35 ng/mL (sensitivity, 0.95; specificity, 0.97). Survival analysis showed a statistically significant difference in all-cause and cardiovascular mortalities for the group with an initial cTnT > or =0.35 ng/mL compared to the other groups. Initial serum cTnT concentration was an independent predictor for mortality. CONCLUSION: Because ESRD patients with an initial cTnT concentration > or =0.35 ng/mL have a poor prognosis, it is suggested that urgent diagnosis and treatment be indicated in dialysis patients with ACS when the initial cTnT levels are > or =0.35 ng/mL.
Acute Coronary Syndrome/blood/complications/*diagnosis/mortality
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Aged
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Biological Markers/blood
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Female
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Humans
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Kidney Failure, Chronic/blood/complications/*diagnosis/mortality
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Male
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Middle Aged
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Prognosis
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Retrospective Studies
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Sensitivity and Specificity
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Troponin T/*blood
2.Lysophosphatidylcholine, Oxidized Low-Density Lipoprotein and Cardiovascular Disease in Korean Hemodialysis Patients: Analysis at 5 Years of Follow-up.
Young Ki LEE ; Dong Hun LEE ; Jin Kyung KIM ; Min Jeong PARK ; Ji Jing YAN ; Dong Keun SONG ; Nosratola D VAZIRI ; Jung Woo NOH
Journal of Korean Medical Science 2013;28(2):268-273
Although oxidized low-density lipoprotein (LDL) and lysophosphatidylcholine (LPC) have been proposed as important mediators of the atherosclerosis, the long-term contribution to the risk of cardiovascular disease (CVD) in hemodialysis patients has not been evaluated. This study investigated the relation between oxidized LDL and LPC levels with long term risk of CVD. Plasma oxidized LDL and LPC levels were determined in 69 Korean hemodialysis patients as a prospective observational study for 5 yr. During the observation period, 18 cardiovascular events (26.1%) occurred including 6 deaths among the hemodialysis patients. The low LPC level group (< or = 254 microM/L, median value) had much more increased risk of CVD compared to the high LPC level group (> 254 microM/L) (P = 0.01). However, serum levels of oxidized LDL were not significantly different between groups with and without CVD. In adjusted Cox analysis, previous CVD, (hazard ratio [HR], 5.68; 95% confidence interval [CI], 1.94-16.63, P = 0.002) and low LPC level (HR, 3.45; 95% CI, 1.04-11.42, P = 0.04) were significant independent risk factors for development of CVD. It is suggested that low LPC, but not oxidized LDL, is associated with increased risk of CVD among a group of Korean hemodialysis patients.
Adult
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Aged
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Asian Continental Ancestry Group
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Cardiovascular Diseases/*diagnosis/etiology/mortality
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Case-Control Studies
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Female
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Follow-Up Studies
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Humans
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Kidney Failure, Chronic/blood/complications/diagnosis
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Lipoproteins, LDL/*blood
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Lysophosphatidylcholines/*blood
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Male
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Middle Aged
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Proportional Hazards Models
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Prospective Studies
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Renal Dialysis
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Republic of Korea
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Risk Factors