Association of circulating cardiac biomarkers with electrocardiographic abnormalities in chronic kidney disease

Author:

Kula Alexander J1ORCID,Katz Ronit2,Zelnick Leila R2,Soliman Elsayed3,Go Alan4,Shlipak Michael5,Deo Rajat6,Ky Bonnie6,DeBoer Ian2,Anderson Amanda7,Christenson Rob8,Seliger Stephen L8,Defilippi Chris9,Feldman Harold I610,Wolf Myles11,Kusek John12,Shafi Tariq13,He Jiang7,Bansal Nisha2

Affiliation:

1. Division of Pediatric Nephrology, Seattle Children's Hospital, University of Washington, Seattle, WA, USA

2. Division of Nephrology, Kidney Research Institute, University of Washington, Seattle, WA, USA

3. Department of Medicine, School of Medicine, Wake Forest University, Winston-Salem, NC, USA

4. Division of Research, Kaiser Permanente Northern California, San Francisco, CA, USA

5. Department of General Internal Medicine, San Francisco VA Medical Center, San Francisco, CA, USA

6. Departments of Medicine and Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

7. Translational Science Institute School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA

8. Department of Medicine, University of Maryland School of Medicine, Baltimore, LA, USA

9. Inova Heart and Vascular Institute, Falls Church, VA, USA

10. Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

11. Department of Medicine, School of Medicine, Duke University, Durham, NC, USA

12. National Institute of Diabetes, Digestive, and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA

13. Division of Nephrology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA

Abstract

Abstract Background Among patients with chronic kidney disease (CKD), the circulating cardiac biomarkers soluble ST2 (SST2), galectin-3, growth differentiation factor-15 (GDF-15), N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity troponin-T (hsTnT) possibly reflect pathophysiologic processes and are associated with clinical cardiovascular disease. Whether these biomarkers are associated with electrocardiographic findings is not known. The aim of this study was to test the association between serum cardiac biomarkers and the presence of electrocardiographic changes potentially indicative of subclinical myocardial disease in patients with CKD. Methods We performed a cross-sectional analysis using 3048 participants from the Chronic Renal Insufficiency Cohort (CRIC) without atrial fibrillation, atrioventricular block, bundle branch block or a pacemaker at the baseline visit. Using logistic regression, we tested the association of each of the five cardiac biomarkers with baseline electrocardiogram (ECG) findings: PR interval >200 ms, QRS interval >100 ms and a prolonged QTc interval. Models were adjusted for demographic variables, measures of kidney function, prevalent cardiovascular disease and cardiovascular risk factors. Results In adjusted models, hsTnT levels associated with prolonged PR {odds ratio [OR] 1.23 [95% confidence interval (CI) 1.08–1.40]}, QRS [OR 1.28 (95% CI 1.16–1.42)] and QTc [OR 1.94 (95% CI 1.50–2.51)] intervals. NT-proBNP levels were associated with prolonged QRS [OR 1.11 (95% CI 1.06–1.16)] and QTc [OR 1.82 (95% CI 1.58–2.10)] intervals. SST2, galectin-3 and GDF-15 were not significantly associated with any of the ECG parameters. Conclusions hsTnT and NT-proBNP were associated with ECG measures indicative of subclinical myocardial dysfunction. These results may support future research investigating the significance of myocardial ischemia and volume overload in the pathogenesis of dysfunctional myocardial conduction in CKD.

Funder

National Institute of Diabetes and Digestive and Kidney Diseases

National Institutes of Health

Publisher

Oxford University Press (OUP)

Subject

Transplantation,Nephrology

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