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Clinical Chemistry 43: 976-982, 1997;
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(Clinical Chemistry. 1997;43:976-982.)
© 1997 American Association for Clinical Chemistry, Inc.

Articles

Cardiac troponin I, cardiac troponin T, and creatine kinase MB in dialysis patients without ischemic heart disease: evidence of cardiac troponin T expression in skeletal muscle

Mary D. McLaurin1, Fred S. Apple2,a, Ellen M. Voss2, Charles A. Herzog1 and Scott W. Sharkey1

1 Departments of Medicine and Cardiology and
2 Laboratory Medicine and Pathology, Hennepin County Medical Center, and University of Minnesota Medical School, Minneapolis, MN 55415.
a Author for correspondence: Hennepin County Medical Center, Clinical Laboratories MC 812, 701 Park Ave., Minneapolis MN 55415. Fax 612-904-4229; e-mail fred.apple{at}co.hennepin.mn.us

Serum cardiac troponin T (cTnT) concentrations are frequently increased in chronic dialysis patients as measured by the first-generation ELISA immunoassay, as is creatine kinase (CK) MB mass in the absence of acute ischemic heart disease. We designed this study to compare four serum markers of myocardial injury [CK-MB mass, first-generation ELISA cTnT, second-generation Enzymun cTnT, and cardiac troponin I (cTnI)] in dialysis patients without acute ischemic heart disease. We also evaluated skeletal muscle from dialysis patients as a potential source of serum cTnT. No patients in the clinical evaluation group (n = 24) studied by history and by physical examination, electrocardiography, and two-dimensional echocardiography had evidence of ischemic heart disease. Biochemical markers were measured in serial predialysis blood samples with specific monoclonal antibody-based immunoassays. For several patients at least one sample measured above the upper reference limit: CK-MB, 7 of 24 (30%); ELISA cTnT, 17 of 24 (71%); Enzymun cTnT, 3 of 18 (17%); and cTnI, 1 of 24 (4%). In a separate group of dialysis patients (n = 5), expression of cTnT, but not cTnI, was demonstrated by Western blot analysis in 4 of 5 skeletal muscle biopsies. Chronic dialysis patients without acute ischemic heart disease frequently had increased serum CK-MB and cTnT. The specificity of the second-generation cTnT (Enzymun) assay was improved over that of the first-generation (ELISA) assay; cTnI was the most specific of the currently available biochemical markers. cTnT, but not cTnI, was expressed in the skeletal muscle of dialysis patients.


Key Words: indexing terms: enzyme immunoassay • renal failure • heart function




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