ABSTRACT
Cardiovascular disease accounts for approximately 50% of deaths in patients with end-stage renal disease [ESRD]. Identifying those ESRD patients at high risk for future events is challenging, because they often have silent ischemia or atypical expressions of angina. Use of ECG data as diagnostic and prognostic tools is also difficult in this population because of the high prevalence of left ventricular hypertrophy and electrolyte disturbarices. Renal failure is one of the conditions in which serum markers of myocardial damage are falsely elevated. It is well known that levels of creatine kinase, CK-MB and myoglobin are altered in patients with uremia. Angina may be atypical or not observed due to silent ischemia and can be caused by factors other than coronary artery disease. In addition, nonspecific electrocardiogram findings are very common in these patients due to electrolyte imbalance, left ventricular hypertrophy and drug effects. Therefore, the value of specific biochemical markers of myocardial injury is crucial to this patient population. In some studies it is demonstrated that elevated cardiac troponins are a sign of coronary artery disease when these patients were investigated invasively by angiography, or non-invasively using stress cardiac isotopic imaging. Aim of the study: Evaluation of the role of cardiac troponin I in the diagnosis of myocardial injury in patients -under regular dialysis. The Study included 69 patients were selected from dialysis unit in El Minia university hospital. They are classified into three groups. Group I 25 patients with chronic renal failure under regular dialysis and proven not to have cardiac events [myocardial infarction, unstable angina, any anginal pains, congestive heart failure]. Group II Included 19 patients with chronic renal failure under regular dialysis proven to have cardiac events and Group III Included 25 apparently healthy subjects matched for age and sex their ages All the patients and controls were subjected to the following: History taking, general examination. Laboratory investigations [Complete blood count [CBC], BUN, serum creatinine, AST, serum phosphorous and ionized calcium ,lipid profile, C-reactive protein, LDH, CK,CK- MB and cardiac troponin I. Resting 12- leads ECG, and echocardiography. There was highly significant difference between group I, II and group Ill as regards BUN, serum creatinine, phosphorous and C- reactive protein and highly significant difference between group I and group U while significant difference between group II and III as regards serum calcium. There was highly significant difference between group I, II versus group II and III as regards serum triglycerides, HDL-cholesterol and LDL-cholesterol, but significant difference between group I, Ill and highly significant difference between group II, III as regards total cholesterol. There was highly significant difference between group I, II versus III as regards AST, LDH, CK, and CK -MB also high significant difference between group1, II and control as regards troponin. Conclusions: Cardiac troponin I can predicts myocardial infarction in patients with chronic renal failure on regular hemodialysis