Troponin I and Cardiovascular Events in Transplant Patients

Abstract

We have carefully read the recently published article in Transplantation by Claes et al. (1). The authors clearly demonstrated that elevated pretransplant troponin I is an independent predictor of major adverse cardiac events in transplant patients. Recently, we have demonstrated that in asymptomatic hemodialysis patients, silent myocardial damage as defined by elevated cardiac troponin I (cTnI) levels were associated with both traditional and nontraditional cardiovascular risk factors. Among the factors related with elevated cTnI were found to be diabetes mellitus, left ventricular hypertrophy, uncontrolled blood pressure, normalized protein equivalent of total nitrogen appearance, hemoglobin, and tumor necrosis factor-α (2). In common with our study, Claes et al. also reported that troponin I levels were correlated with the presence of diabetes and C-reactive protein. Thus, by the light of these two studies, we believe that some of the factors for elevated cTnI levels may be predictable (e.g., diabetes, inflammation). Because elevated cTnI is found to be a risk factor for future cardiac events, including myocardial infarction, cardiac death, and revascularization in asymptomatic patients with chronic renal failure (3–5), factors related with elevated cTnI level should also be defined. Bearing these issues in mind, we wonder whether Claes et al. would give further information whether the blood pressure measurements and the presence of hypertension at the time of transplantation were related with elevated troponin I levels. We also wonder whether any nutritional parameter other than albumin were related with elevated troponin I levels. Finally, we would like to learn whether the authors suggest routine coronary angiography to patients with elevated troponin I levels. Baris Afsar Rengin Elsurer Department of Nephrology Zonguldak Atatürk Government Hospital Zonguldak, Turkey