الفهرس 
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Abstract
Chronic kidney disease is a worldwide public health problem and is now recognized as a common condition that is associated with an increased risk of cardiovascular disease and chronic renal failure.Cardiovascular disease is the leading cause of mortality and morbidity in patients with chronic kidney disease.
Cardiovascular disease is frequently associated with CKD, which is important, since individuals with CKD are more likely to die of cardiovascular disease than to develop kidney failure. Indeed, the term cardiorenal syndrome has been increasingly used, and a new classification was proposed because a large proportion of patients admitted to the hospital have various degrees of heart and kidney dysfunction.
Recent clinical studies have shown the strong prognostic significance of elevated troponin levels in patients with CKD.
In patients with renal failure, conventionally assessed cTnT levels may be elevated simply owing to delayed cTnT clearance.
A highly sensitive (hs) assay for cardiac troponin T (cTnT) has recently been developed, which determines concentrations that are lower by a factor of 10 than those measurable with conventional assays. In patients with chronic heart failure and chronic coronary artery disease (CAD) circulating cTnT is detectable in almost all individuals with the highly sensitive assay, and higher levels correlate strongly with increased cardiovascular mortality.
Recent development in methods to monitor the cardiac troponin T (cTnT) level have provided an improved understanding of its role in various diseses, particulary in cardiovascular diseases. As hs-cTnT elevation is associated with various disease conditions.
In patients with heart failure with a normal EF, concentric hypertrophy or remodeling can be observed. In addition, several studies have demonstrated an independent association between troponin levels and the presence of LVH in non-dialysis CKD patients.
In this study, we tried to assess the relationship between serum hs-cTnT level and LVDD grade in non-dialysis CKD patients.
The aim of this study is to find the relationship between hs-cTnT values and LVDD in non-dialysis CKD patients without clinically apparent heart failure as diagnosing LVDD could possibly lead to improved treatments and may have substantial health care implications, from both clinical and resource utilization perspectives.
This study included eighty patients, 60 of them were chronic kidney disease (stage II, III and IV) on conservative therapy, there were 25 males and 35 females and 20 of them were healthy control; they were 10 males and 10 females.
All the studied groups were subjected to the following
1-History taking including
Age, sex, height and duration of disease.
History of any previous renal disease.
History of any previous cardiac disease .
2-Thorough physical examination of all body systems.
3- Laboratory Investigations
1- Complete Blood Count (CBC)
2- complete urine analysis.
3- Kidney function tests (urea & Creatinine)
4- Estimated creatinine clearance (eCCr ) using Cockcroft-Gault
5- Estimation of lipid profile (including total cholesterol and triglycerides)
6- Erthrocyte sedimentation rate & C-reactive protein.
7- Fasting and 2h-post prandial blood sugar.
8- serum high sensitive cardiac troponin-T.
3-Radiological investigations:
Echocardiography was performed using a cardiac ultrasound unit with a 2- to 3.5-MHz transducer. Left ventricular (LV) end-diastolic/-systolic dimensions and end-diastolic/-systolic wall thickness of the interventricular septum and LV wall were
determined using standard echocardiographic 2-D and M-mode measurements. Both EF and LV mass (LVM) were calculated from the M-mode echocardiogram. Left ventricular hypertrophy LVH was defined as the LVM index (LVMI) >125 g/m2 in males and >110 g/m2 in females. Mitral inflow velocity was traced, and the following variables were derived: peak early (E) and late (A) transmitral flow velocities, and the ratio of early/late peak velocities (E/A) to determine LVDD grade based on the guidelines of the American Society of Echocardiography.
Our study examined the relationship between serum hs-cTnT level and LVDD grade in non-dialysis CKD patients.
from the result of this work we found that there is a significant statistical positive correlation between high sensitive cardiac troponin-T and Left ventricular diastolic dysfunction grade in CKD patients group (Non –Heamodialysis patients).
According to high sensitive troponin-T level, cases group ranged from (20.4 – 600.0 ng/L) with mean (± SD is 163.60 ± 156.40) and median (107.0) while in control group ranged from (3.0 – 13.90 ng/L) with mean (± SD is 7.48 ± 3.53) and median (7.15)
The mean value of High sensitive troponin-T is significantly higher among patients group than cases group. (P-value <0.001*).
There is a significant statistical positive correlation between the hs-cTnT and LVDD grade in patients group. (P value <0.001)
In our study, usin ROC analysis, we found that the performance of Hs-cTnT to differentiate between grade I (asymptomatic) and grade II (symptomatic) left ventricular diastolic dysfunction is significant.(AUC=0.956) (P<0.001)
With cutoff (70.2 ng/L), Hs-cTnT can differentiate between grade I and grade II with sensitivity (84.62 %) and specificity (100.0 %) and accuracy (90.0 %).
There is a significant statistical positive correlation between the hs-cTnT and CKD stage in patients group. (P value <0.001)
There is a significant statistical positive correlation between the hs-cTnT and serum cholesterol level in patients group. (P value <0.049)
There is no significant statistical positive correlation between the hs-cTnT and serum triglyceride level in patients group. (P value <0.180)
There is significant statistical positive correlation between LVDD grade and CKD stage in patient group. (P value <0.001)
There is no significant statistical difference between patients with CKD & control group regarding the gender. (P-value =0.515).
According to age, the cases group ranged from (45.0 – 63.0 y) with mean (± SD is 56.03 ± 5.79) and median (56.0) while the cases group ranged from (45.0 – 65.0 y) with mean (± SD is 55.65 ± 7.28) and median (56.50).
There is no significant statistical difference between patients with CKD & control group regarding age. (P-value =0.811).
According to serum creatinine, cases group ranged from (1.70 – 7.0 mg/dl) with mean (± SD is 3.24 ± 1.44) and median (3.0) while control group ranged from (0.50 – 7.0 mg/dl) with mean (± SD is 1.33 ± 1.36) and median (1.05)
The mean value of serum creatinine is significantly higher among patients group than cases group.(P-value <0.001*).
According to GFR %, cases group ranged from (21.0 – 87.0 ml/min) with mean (± SD is 52.28 ± 20.44) and median (48.0) while control group ranged from (90.0 – 95.0 ml/min) with mean (± SD is 93.10 ± 1.29) and median (93.0)
The mean value of GFR % is significantly higher among cases group than patients group .(P-value <0.001*).
According to FBS , cases group ranged from (79.0 – 99.0 mg/dl) with mean (± SD is 92.22 ± 5.49) and median (93.0) while control group ranged from (85.0 – 98.0 mg/dl) with mean (± SD is 92.90 ± 5.12) and median (94.50)
The mean value of FBS is no significantly higher among patients group than cases group. (P-value=0.625). According to 2h-PP, cases group ranged from (100.0 – 129.0 mg/dl) with mean (± SD is 114.43 ± 7.08) and median (114.0) while control group ranged from (100.0 – 120.0 mg/dl) with mean (± SD is 112.85 ± 4.84) and median (113.50)
The mean value of FBS is no significantly higher among patients group than cases group.(P-value=0.356).
According to haemoglobin level, cases group ranged from( 8.70 – 11.0 g/dl) with mean (± SD is 9.78 ± 0.62 ) and median ( 9.95 ) while control group ranged from (12.0 – 13.30 g/dl) with mean (± SD is 12.53 ± 0.54 ) and median ( 12.50 )
The mean value of hemoglobin (Hb) level is significantly higher among cases group than patient group.(P-value <0.001 ).
According to s. cholesterol, cases group ranged from (144.0 – 350.0 mg/dl) with mean (± SD is 214.45 ± 56.68) and median (190.0) while control group ranged from ( 110.0 – 199.0 mg/dl) with mean (± SD is 165.20 ± 22.77) and median (165.0)
The mean value of s. cholesterol is significantly higher among patients group than cases group.(P-value <0.001*).
According to s.triglycerides, cases group ranged from (105.0 – 410.0 mg/dl) with mean (± SD is 189.48 ± 58.0) and median (189.0) while control group ranged from (121.0 – 158.0 mg/dl) with mean (± SD is 139.40 ± 12.44) and median (143.50)
The mean value of s. triglycerides is significantly higher among patients group than cases group.(P-value <0.001*)