[The value of troponin T as a marker of ischemic heart disease in renal insufficiency].

Cardiovascular mortality in patients with Chronic Renal Failure (CRF) is high. Cardiac Troponins (Tn) are today the most specific biomarkers for myocardial damage, although they may be elevated in situations other than the Acute Coronary Syndrome (ACS). Its elevation is mandatory to diagnose AMI, although other simultaneous factors are necessary for the diagnosis. In any patient with a clinical presentation compatible with ACS any increase in Tn indicates AMI and high risk, thus conditioning more aggressive treatment. In CRF cardiac Tn are elevated at baseline in a variable magnitude and in a different percentage of patients according to the degree of renal failure and the number of risk factors which favour such elevation. The reasons for it are not clear. Nevertheless, the clinical interpretation and attitude when there is a suspicion of ACS must be the same in the general population and in patients with CRF. In case of doubt serial samples of Tn may be useful to suggest myocardial damage. On the other side, in asymptomatic patients with or without CRF its elevation at baseline seems to be an independent marker of risk for both global and cardiac mortality. Despite the probability of basal elevation of Tn in patients with CRF, its routine measurement is not recommended neither to compare it with the value obtained in a situation of suspicion of ACS, because the serial samples obtained during the event give more accurate information, nor for stratification of mortality risk, because there is no data to confirm that a therapeutic intervention or an aggressive diagnostic measure based on chronic elevations of Tn are useful. In the general population both TnI and TnT give similar information, but in patients with CRF TnT is clearly preferred.