Troponin I and cardiovascular events in transplant patients.

摘要

We have carefully read the recently published article in Transplantation by Claes et al. (1). The authors clearly demonstrated that elevated pre-transplant 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 (cTnl) levels were associated with both traditional and nontraditional cardiovascular risk factors. Among the factors related with elevated cTnl were found to be diabetes mellitus, left ventricular hypertrophy, uncontrolled blood pressure, normalized protein equivalent of total nitrogen appearance, hemoglobin, and tumor necrosis factor-alpha (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 cTnl levels may be predictable (e.g., diabetes, inflammation). Because elevated cTnl 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 cTnl 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.