Association of maximal stress ergometry performance with troponin T and abdominal aortic calcification score in advanced chronic kidney disease

Roosa Lankinen, Markus Hakamäki, Kaj Metsärinne, Niina Koivuviita, Jussi P Pärkkä, Maria Saarenhovi, Tapio Hellman, Mikko J Järvisalo, Roosa Lankinen, Markus Hakamäki, Kaj Metsärinne, Niina Koivuviita, Jussi P Pärkkä, Maria Saarenhovi, Tapio Hellman, Mikko J Järvisalo

Abstract

Background: Cardiac biomarkers Troponin T (TnT) and N-terminal pro-B-type natriuretic peptide (proBNP) and abdominal aortic calcification score (AAC) are associated with cardiovascular events and mortality in patients with chronic kidney disease (CKD). The effects of cardiac biomarkers and AAC on maximal exercise capacity in CKD are unknown and were studied.

Methods: One hundred seventy-four CKD 4-5 patients not on maintenance dialysis underwent maximal bicycle ergometry stress testing, lateral lumbar radiograph to study AAC, echocardiography and biochemical assessments.

Results: The subjects with proportional maximal ergometry workload (WMAX%) less than 50% of the expected values had higher TnT, proBNP, AAC, left ventricular end-diastolic diameter, left ventricular mass index, E/e' and pulse pressure, and lower global longitudinal strain compared to the better performing patients. TnT (β = - 0.09, p = 0.02), AAC (β = - 1.67, p < 0.0001) and diabetes (β = - 11.7, p < 0.0001) remained significantly associated with WMAX% in the multivariable model. Maximal ergometry workload (in Watts) was similarly associated with TnT and AAC in addition to age, male gender, hemoglobin and diastolic blood pressure in a respective multivariate model. AAC and TnT showed fair predictive power for WMAX% less than 50% of the expected value with AUCs of 0.70 and 0.75, respectively.

Conclusions: TnT and AAC are independently associated with maximal ergometry stress test workload in patients with advanced CKD.

Trial registration: http://www.ClinicalTrials.gov NCT04223726.

Keywords: Aortic calcification; Chronic kidney disease; Echocardiography; Ergometry stress test; Troponin T.

Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Area under the curve (AUC) of receiver operating characteristics curve (ROC) analyses for Troponin T (TnT) (left panel) an abdominal aortic calcification (AAC) score (right panel) in relation to maximal proportional stress ergometry workload of less than 50% of the expected normal value

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Source: PubMed

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