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PubMed2002

A cross-sectional study of clinical thrombotic risk factors and preventive treatments in antiphospholipid syndrome.

OBJECTIVE: Antiphospholipid antibodies (aPL) are major risk factors for thrombosis. Other clinical factors exist in antiphospholipid syndrome (APS) patients which may have an additive or preventive effect on thrombosis. We therefore performed a cross-sectional study to analyse additive clinical thrombotic risk factors and possible preventive treatments in APS patients, and to compare the results with those obtained in asymptomatic aPL-positive (no history of vascular thrombosis or pregnancy morbidity) patients. METHODS: We identified 77 APS patients with non-gravid thrombotic events (group A) and 56 asymptomatic aPL-positive patients (group B). The study periods were defined as 6 months prior to the time of first vascular event in group A and 6 months prior to the patient's last visit in group B. Medical records were reviewed to evaluate the incidence of hypertension, diabetes mellitus, hypercholesterolaemia, regular cigarette smoking, oral contraceptive use or hormone replacement therapy, surgical procedures, pregnancy with or without an APS-related event, malignancy and infections. In addition, any history of thrombocytopenia or the use of aspirin, hydroxychloroquine, corticosteroids or immunosuppressives during the study periods was recorded. Bivariate statistical analysis and logistic regression tests were performed to compare groups. RESULTS: In group A, 75% (n=58) of patients and in group B 48% (n=27) of patients had at least one of the additional risk factors during the study periods. In the bivariate analysis, pregnancy (P=0.005) and surgical procedures (P=0.04) were significantly more frequent in group A, while aspirin (P<0.001), hydroxychloroquine (P<0.001) and corticosteroids (P=0.002) were used significantly more frequently in group B. In logistic regression, the probability of an event was decreased by taking aspirin and/or hydroxychloroquine. In women only, the probability of an event was increased with thrombocytopenia and pregnancy or surgical procedures. The incidences of hypertension and smoking and the presence of more than one risk factor were significantly associated with arterial thrombosis but not venous thrombosis. CONCLUSION: While traditional risk factors were similar between groups, pregnancy and surgical procedures increased the risk of thrombosis. Hypertension and smoking were associated with arterial events. Possessing a combination of risk factors may increase the occurrence of arterial thrombosis but not venous thrombosis. Use of aspirin and/or hydroxychloroquine may be protective against thrombosis in asymptomatic aPL-positive individuals.

Antiphospholipid Syndrome↗
PubMed2005

Cold periods and coronary events: an analysis of populations worldwide.

STUDY OBJECTIVE: To investigate the association between cold periods and coronary events, and the extent to which climate, sex, age, and previous cardiac history increase risk during cold weather. DESIGN: A hierarchical analyses of populations from the World Health Organisation's MONICA project. SETTING: Twenty four populations from the WHO's MONICA project, a 21 country register made between 1980 and 1995. PATIENTS: People aged 35-64 years who had a coronary event. MAIN RESULTS: Daily rates of coronary events were correlated with the average temperature over the current and previous three days. In cold periods, coronary event rates increased more in populations living in warm climates than in populations living in cold climates, where the increases were slight. The increase was greater in women than in men, especially in warm climates. On average, the odds for women having an event in the cold periods were 1.07 higher than the odds for men (95% posterior interval: 1.03 to 1.11). The effects of cold periods were similar in those with and without a history of a previous myocardial infarction. CONCLUSIONS: Rates of coronary events increased during comparatively cold periods, especially in warm climates. The smaller increases in colder climates suggest that some events in warmer climates are preventable. It is suggested that people living in warm climates, particularly women, should keep warm on cold days.

Adult↗
PubMed1987

Periodic breathing and hypoxia in snorers and controls: validation of snoring history and association with blood pressure and obesity.

Fifty-two men (aged 41-50 years) of whom 25 reported habitual and 27 of occasional or never snoring were examined clinically. Whole-night sleep recordings of body and breathing movements, snoring and blood oxygen saturation were made. Hypoxic events exceeding 4% from the baseline were counted. Ninety-three percent of those classified snorers by the recordings were habitual or occasional snorers, but 50% of those similarly classified non-snorers had reported habitual or occasional snoring. Four habitual snorers had abnormal breathing indices and polysomnography established obstructive sleep apnea syndrome (OSAS) in one. Thus, self-reported habitual snoring is a reliable OSAS-screening method. Estimated prevalence of OSAS based on this study is 0.4-1.4%. In multivariate regression analysis, the hypoxic events were explained by obesity and apneic events. The diastolic blood pressure level was best explained by obesity, but not hypoxic or apneic events or snoring history.

Adult↗
PubMed1994

Lp(a) and premature mortality during chronic hemodialysis treatment.

Lipoprotein(a) levels are approximately three to four times higher in patients with end-stage renal disease (ESRD) when compared to controls with normal renal function (H.J. Parra, H. Mezdour, C. Cachera et al., Clin. Chem. 33 (1987), 721). Hypertriglyceridemia occurs in approximately 50% of ESRD patients receiving chronic hemodialysis (HD) treatment and has been associated with an increased prevalence of cardiovascular disease (CVD) in cross-sectional studies of this subset of ESRD patients. We recently reported that HD patients with pre-existing ischemic or atherosclerotic CVD and patients with elevated Lp(a) levels had an increased risk of fatal and non-fatal clinical events attributable to CVD during a 48-month period of maintenance HD treatment. The current report describes a detailed analysis of study participants who did or did not have a history of ischemic CVD or angiographically documented severe atherosclerotic lesions prior to entry into our prospective study. Although baseline total cholesterol (TC), triglyceride (TG) and apoprotein B (apoB) levels were higher in the 36 participants with prevalent CVD than the remaining 93 study participants, total cholesterol levels were somewhat lower, while serum triglyceride levels were no different in patients who survived or experienced fatal CVD events during the period of observation on HD treatment. In contrast, Lp(a) levels were no different in participants with or without evidence of pre-existing CVD. Lp(a) was, however, an independent predictor of fatal events attributable to cardiovascular disease during the period of follow-up.

Adult↗
PubMed2004

Apolipoprotein B determines risk for recurrent coronary events in postinfarction patients with metabolic syndrome.

The adult treatment panel III (ATP III) of the National Cholesterol Education Program recognizes metabolic syndrome (MS) as a secondary target for risk-reduction therapy given the well-known increase in risk of cardiovascular disease (CVD) by all MS components. We investigated potential CVD risk arising from 17 laboratory variables in postinfarction patients with MS by identifying such patients from the Thrombogenic Factors and Recurrent Coronary Events (THROMBO) study using slightly modified ATP III criteria for MS. This gave 272 patients with MS out of a total of 766 postinfarction patients without history of diabetes. Comparison between non-MS and MS patients using Kaplan-Meier analysis revealed no difference in outcome between groups. Additionally, a proportional hazards model applied to dichotomized laboratory parameters demonstrated only apoB as a significant predictor of risk for recurrent coronary events in MS patients with hazard ratio, 1.97 (95% CI; 1.08, 3.60; P < 0.05). We conclude that there is no difference in outcomes between non-MS and MS postinfarction patients; that apoB is significantly associated with risk for recurrent coronary events in postinfarction patients with MS; that further studies would be needed to recommend the routine determination of apoB in these patient groups.

Apolipoproteins B↗
PubMed1988

Prognostic value and limitations of exercise radionuclide angiography in medically treated coronary artery disease.

We investigated whether exercise radionuclide angiography provides prognostic information in addition to that identified by resting left ventricular function and coronary anatomy in patients with medically treated coronary artery disease. Clinical follow-up (median, 21.7 months) was obtained in 424 medically treated patients who underwent exercise radionuclide angiography and coronary angiography. The mean age of the study population was 58 years, and 67% were men. Cardiac death occurred in 16 patients, nonfatal myocardial infarction in 16, and nonfatal out-of-hospital cardiac arrest in 1. Univariate analysis showed that multiple variables were associated with future cardiac events, including number of diseased vessels, exercise and rest radionuclide ejection fraction, history of myocardial infarction, exercise and rest left ventricular end-systolic and end-diastolic volume indices, peak exercise workload, age, abnormal resting electrocardiogram, and peak exercise ST-segment depression. Only three variables were independently associated with cardiac events on follow-up: number of diseased vessels, radionuclide ejection fraction at rest, and age. In patients with three-vessel disease and a resting radionuclide ejection fraction of more than 40%, a subgroup with higher risk could not be identified on the basis of exercise radionuclide response.

Coronary Angiography↗
PubMed2002

Phylogeographic analysis of a recent radiation of Enallagma damselflies (Odonata: Coenagrionidae).

A phylogenetic hypothesis revealed two recent radiations among species of Enallagma damselflies, and extensive ecological work suggests that both adaptive and nonadaptive processes are involved in these radiations. We analysed the geographical pattern of genetic variability at 868 bp of mitochondrial DNA (mtDNA) among 283 individuals of 5 species displaying little ecological differentiation to identify the ancestral lineage, support their independent evolutionary trajectories and identify historical events and the underlying mechanism for one of these radiations. Nested clade analysis results clearly support a past event of range fragmentation in E. hageni. These Atlantic and Continental hageni races experienced distinct dispersal histories and still maintain nearly nonoverlapping ranges All four other species derive from the Continental hageni. Whereas three species endemic to the Atlantic coastal plain show little genetic variation, E. ebrium shared several haplotypes with the Continental hageni. Contrasting levels of genetic differentiation between E. hageni and E. ebrium in geographical areas associated with distinct events of E. hageni's recent history support the recent origin of this species. Altogether, our results are compatible with a process of radiation via divergence in mate recognition systems within the Continental hageni race following secondary contacts between putative refugial races.

Animals↗
PubMed1987

Changes in monophasic action potential duration during the first hour of regional myocardial ischaemia in the anaesthetised pig.

The effects of ischaemia on monophasic action potential duration and conformation were studied using suction electrodes on the in situ left ventricle in anaesthetised pigs. Action potentials were recorded throughout the first hour of ischaemia and their behaviour studied on a beat to beat basis by computer analysis. The natural history of action potential duration changes in the ischaemic area was based on the presence or absence of four events. Typically, ischaemic segments showed a brief increase in action potential duration after coronary ligation (event 1), followed by a rapid fall in action potential duration (event 2), a temporary, partial, spontaneous recovery of action potential duration after about 15 min (event 3), and, finally, a decay towards inexcitability of the segment (event 4). An increase in variability of action potential duration was associated with event 2, sometimes manifest as electrical alternans. Simultaneous records from control segments of non-ischaemic myocardium were relatively unchanged. Segments of myocardium bridging the cyanotic border sometimes showed the events. Non-uniform or dispersed event 3 in ischaemia, coupled with the increased beat to beat variability after event 2, could establish the conditions for ventricular arrhythmias and fibrillation.

Action Potentials↗
PubMed1997

Predictive risk factors of residual cholesteatoma in children: a study of 256 cases.

OBJECTIVE: This study aimed to determine which children are at risk of having residual cholesteatoma develop after initial surgery for either cholesteatoma or severe retraction pocket. This study aimed to identify the characteristics of each patient and assessing whether predictive factors exist to propose a well-guided therapeutic approach. DESIGN: This was a retrospective study. Mean follow-up period (after the last eradication intervention) was 42 months. PATIENTS: Two hundred thirty-one children (256 ears) with either cholesteatoma (n = 157) or severe retraction pockets (n = 99), both treated surgically, composed the patient group. METHODS STATISTICAL ANALYSIS: univariate analysis of event-free survivals (using log-rank test and Kaplan-Meier estimate) and multivariate analysis (using Cox regression model) of clinical history, surgical observations, residuals occurrence (using Kaplan-Meier's statistical method) were used. RESULTS: Posterior mesotympanum involvement, ossicular chain interruption after disease excision (and moreover combination of both), relative lack of experience of the surgeon, and presumed incomplete removal were identified as independent risk factors highly correlated with residuals' development (relative risks ranging from 2.02-4.84). Disease extension, type of process (cholesteatoma vs. retraction pocket), eventual surgical history, and surgical method initially used (closed or open) showed no such correlation. CONCLUSION: The identification of any of these factors should instigate a mandatory second-look procedure regardless of other initial surgical findings and of technique used. The authors propose to advance this procedure from 12 to 9 months when all these factors are found in one child.

Adolescent↗
PubMed2005

Cost-effectiveness of atorvastatin for the prevention of coronary and stroke events: an economic analysis of the Anglo-Scandinavian Cardiac Outcomes Trial--lipid-lowering arm (ASCOT-LLA).

BACKGROUND: The aim of this study is to assess the cost-effectiveness of the lipid-lowering arm of the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT-LLA) where patients from seven countries with hypertension and no history of coronary heart disease (CHD) were randomized to receive 10 mg atorvastatin or placebo. DESIGN: Economic analysis of a randomized controlled trial. METHODS: Data on resource use were aggregated for all patients during the entire trial period (median 3.3 years) and multiplied with unit costs for Sweden and the UK. The total number of cardiovascular events and procedures avoided was used as the measure of effectiveness. RESULTS: Patients treated with atorvastatin had an additional net costs of 449 euro (4114 SEK) in Sweden and 414 euro (260 pounds sterling) in the UK, but fewer events per patient (0.097 compared to 0.132). The incremental cost-effectiveness ratios were 12673 euro (116119 SEK) and 11693 euro (7349 pounds sterling) per event avoided. CONCLUSION: Based on comparisons with the WOSCOPS and 4S studies, atorvastatin at 10 mg to treat patients as in the ASCOT study, appears to be a cost-effective strategy.

Atorvastatin↗
PubMed2001

Hierarchical patterns of global human Y-chromosome diversity.

We examined 43 biallelic polymorphisms on the nonrecombining portion of the Y chromosome (NRY) in 50 human populations encompassing a total of 2,858 males to study the geographic structure of Y-chromosome variation. Patterns of NRY diversity varied according to geographic region and method/level of comparison. For example, populations from Central Asia had the highest levels of heterozygosity, while African populations exhibited a higher level of mean pairwise differences among haplotypes. At the global level, 36% of the total variance of NRY haplotypes was attributable to differences among populations (i.e., Phi(ST) = 0.36). When a series of AMOVA analyses was performed on different groupings of the 50 populations, high levels of among-groups variance (Phi(CT)) were found between Africans, Native Americans, and a single group containing all 36 remaining populations. The same three population groupings formed distinct clusters in multidimensional scaling plots. A nested cladistic analysis (NCA) demonstrated that both population structure processes (recurrent gene flow restricted by isolation by distance and long-distance dispersals) and population history events (contiguous range expansions and long-distance colonizations) were instrumental in explaining this tripartite division of global NRY diversity. As in our previous analyses of smaller NRY data sets, the NCA detected a global contiguous range expansion out of Africa at the level of the total cladogram. Our new results support a general scenario in which, after an early out-of-Africa range expansion, global-scale patterns of NRY variation were mainly influenced by migrations out of Asia. Two other notable findings of the NCA were (1) Europe as a "receiver" of intercontinental signals primarily from Asia, and (2) the large number of intracontinental signals within Africa. Our AMOVA analyses also supported the hypothesis that patrilocality effects are evident at local and regional scales, rather than at intercontinental and global levels. Finally, our results underscore the importance of subdivision of the human paternal gene pool and imply that caution should be exercised when using models and experimental strategies based on the assumption of panmixia.

Africa South of the Sahara↗
PubMed1991

A comparison of taxonomic systems for classifying homeless men.

The present study compared the relative merits of two taxonomic systems for classifying homeless men. One system classified homeless men based on their past history of psychiatric disability. The other system classified individuals on the basis of their current psychiatric impairment. Both classification systems displayed significant discriminating power using a set of predictor variables that included demographic variables, childhood happiness, current life satisfaction, social support, stressful life events, and history of homelessness. Based on the percentage of correct classifications the system based on current impairment was superior to the system based on past history.

Demography↗
PubMedDate not supplied

Lived experience of survivors of leukemia or malignant lymphoma.

Individuals (n = 18) in remission from acute leukemia or highly malignant lymphoma were asked to narrate their lived experience of falling ill, of being under treatment, and life following this event. The transcribed texts were analyzed from a phenomenological-hermeneutic perspective, expanded by their medical and social history as related in interviews. The analysis revealed 3 themes: (I) Believed in life, fought for it and came through stronger; (II) Life went on, adapted and found a balance in the new life; (III) Life was over, felt out of control and lost belief in life. Participants in the first 2 groups viewed their quality of life as improved and stated that the struggle had been meaningful and that the experience had made them grow, as a person, related to the experience of gaining new insight or strength. The third group of survivors viewed their quality of life as worse. They found no meaning in their experience and evaluated the situation with bitterness. Thus the core of living through having acute leukemia or highly malignant lymphoma seemed to be to find meaning with it and the profound crisis it meant to them. To help people retell their experiences may be one way of processing this life-threatening disease and treatment and may be one way to developing a sense of meaning and to regain balance in life.

Acute Disease↗
PubMed1993

Factors that predict antiphospholipid immunoreactivity in young people with transient focal neurological events.

OBJECTIVE: To determine if clinical or radiological features in young people with transient focal neurological events may be used to predict the presence of antiphospholipid antibodies (aPL). DESIGN: A combined retrospective and prospective study of young people with transient focal neurological events. Likelihood ratios and confidence intervals were calculated for the proportions; logistic regression analysis was performed to determine features predictive of aPL immunoreactivity. SETTING: A referral hospital and adjacent outpatient clinic. PATIENTS: Sixty-eight patients with one or more transient focal neurological events were screened for aPL. Forty-seven patients were obtained retrospectively from medical record review of every outpatient personally seen by two of us (G.E.T. and S.R.L.) during a 4.5-year period. Twenty-one patients were prospectively added prior to retrospective analysis. Patients older than 50 years or those with multiple sclerosis or epilepsy were excluded. Five patients fulfilling study criteria were excluded because aPL assay results were unavailable. MAIN OUTCOME MEASURES: Transient neurological symptoms, stroke risk factors, occurrence of cerebral or ocular infarct or death, headache history, and serological and radiological studies were systematically obtained. RESULTS: There were 29 aPL-positive patients compared with 39 aPL-negative ones. Features that distinguished the aPL-positive group included more common monocular visual symptoms (38% vs 15%, P = .03), hemisensory symptoms (76% vs 41%, P = .004), and systemic lupus erythematosus (14% vs 0%, P = .03) and less common binocular visual symptoms (28% vs 51%, P = .05), accompanying headache (66% vs 87%, P = .03), and personal (48% vs 74%, P = .03) and family (29% vs 61%, P = .01) history of migraine. No differences were noted between the groups for age, gender, stroke risk factor profile, and radiological features. In a logistic regression analysis, the estimated odds ratio for aPL positivity in patients with monocular visual disturbance, hemisensory symptoms, and no family history of migraine were 5.3, 7.5, and 3.0, respectively, when controlling for the other variables. CONCLUSIONS: Several clinical features of transient focal neurological events in aPL-positive patients distinguish these individuals from their aPL-negative cohort. Amaurosis fugax, unilateral paresthesias, and no family history of migraine may predict aPL positivity in young persons with transient focal neurological deficits.

Adolescent↗
PubMed1993

Can men be trusted? A comparison of pregnancy histories reported by husbands and wives.

Agreement between pregnancies and pregnancy outcomes reported by husbands and wives was assessed in a sample of 857 couples interviewed between June 1989 and July 1990. The respondents were men employed in a semiconductor manufacturing plant in Burlington, Vermont, and their wives. The wives' reports were used as the standard against which the husbands' reproductive histories were evaluated. Measures included sensitivity, specificity, and percentage of agreement. Reports were considered to be congruent if an outcome reported by the husband agreed with the outcome reported by the wife within a period of +/- 6 months. Although men and women reported similar numbers of livebirths (1,478 and 1,500, respectively), men tended to misreport the timing of events; therefore, complete agreement on the numbers and dates of births was only 88.5%. Men also misreported the prevalence of low birth weight (sensitivity, 74%). Specificity was poorer for the younger (< 35 years) and less educated (< or = 12 years) respondents. Husbands' reports of spontaneous abortions had lower sensitivity (71.2%) than their reports of livebirths, particularly among the better educated (66.9%). Induced abortions were frequently omitted by the husbands (sensitivity, 35.1%), and events such as stillbirths or tubal pregnancies were too few in number to permit meaningful analysis. It is concluded that husbands' misreporting of their wives' reproductive histories may be substantial and sufficient to compromise the validity of epidemiologic studies. It would, therefore, be prudent to avoid the use of husbands as proxy informants of their wives' reproductive histories.

Adult↗
PubMed2004

The biopsychosocial domains and the functions of the medical interview in primary care: construct validity of the Verona Medical Interview Classification System.

Factor analysis (FA) is a powerful method of testing the construct validity of coding systems of the medical interview. The study uses FA to test the underlying assumptions of the Verona Medical Interview Classification System (VR-MICS). The relationship between factor scores and patient characteristics was also examined. The VR-MICS coding categories consider the three domains of the biopsychosocial model and the main functions of the medical interview-data gathering, relationship building and patient education. FA was performed on the frequencies of the VR-MICS categories based on 238 medical interviews. Seven factors (62.5% of variance explained) distinguished different strategies patients and physicians use to exchange information, build a relationship and negotiate treatment within the domains of the biopsychosocial model. Three factors, Psychological, Social Inquiry and Management of Patient Agenda, were related to patient data: sociodemographic (female gender, age and employment), social (stressful events), clinical (GHQ-12 score), personality (chance external health locus of control) and clinical characteristics (psychiatric history, chronic illness, attributed presence of emotional distress).

Adolescent↗
PubMed2006

Stress, personality and depressive symptoms in a 6.5 year follow-up of subjects at familial risk for affective disorders and controls.

BACKGROUND: The aim of the study was to identify risk factors in subjects at risk for depressive disorders and controls. METHODS: In a 6.5 year follow-up study we examined the effects of personality (neuroticism, frustration intolerance, rigidity, melancholic type), adverse life events and chronic difficulties on depressive symptoms in 89 high-risk subjects (HRS, siblings and children of patients suffering from an affective disorder), without any mental illness at wave 1 (T1), and 49 controls without any personal and family history of psychiatric disorder at T1. To this end, regression analysis and path analysis using a structural equation model (only for HRS) were performed. RESULTS: Risk factors for depressive symptoms at wave 2 (T2) in HRS comprised acute adverse life events, frustration intolerance (T1) and depressive symptoms (T1). Risk factors for depressive symptoms in controls included chronic difficulties, neuroticism and rigidity. HRS had less stressful life events and the same risk for chronic difficulties, but perceived adverse events as more stressful. LIMITATION: The sample size of the control group is too small for identifying slight effects. CONCLUSION: Our results indicate that the impact on the emergence of depressive symptoms of various risk factors is different in high-risk subjects and controls. High-risk subjects are more sensitive to the depressogenic effects of acute stress and thus avoid potential stressful changes in their life to a higher extent. On the other hand, the influence of persistent factors such as personality traits (neuroticism, rigidity) and chronic difficulties on subsequent depressive symptoms was less pronounced in HRS as compared to controls.

Adult↗
PubMed2001

Cardiac troponins have no prognostic value for acute and chronic cardiac events in asymptomatic patients with end-stage renal failure.

BACKGROUND: Cardiovascular diseases determine overall mortality in patients with end-stage renal failure. Therefore, testing for myocardial ischemia is important. Elevation of cardio-specific troponins have been frequently measured in patients with end-stage renal failure. Thus, we studied systematically whether patients on chronic intermittent hemodialysis without overt coronary heart disease have increased serum levels of cardiac troponin T and cardiac troponin I. After 2 years, the patients were screened again for cardiac events. METHODS AND RESULTS: The patients had no history of angina during the previous 3 months or myocardial infarction (MI) within the previous 2 years. For analysis we used two cardio-specific assays for troponin T as well as for troponin I and compared the results with the CK-MB concentration. In a number of patients serum concentrations were elevated above the reference range as follows: troponin T rapid bedside assay: 41 of 100 patients, troponin I rapid bedside assay: 27 of 100 patients, quantitative measurement oftroponin T: 22 of 100 patients, quantitative measurement oftroponin I: 7 of 100 patients, CK-MB: 2 of 100 patients. The increased serum levels of cardiac troponins were neither the result of uremic perimyocarditis (pericardial effusion), changes in the hemodialysis regimen, pulmonary congestion nor were they consistent with the etiology of renal failure. None of the patients with an elevated troponin level in either of the test suffered from any acute cardiac event initially. Within 2 years 18 of 100 patients died, 13 out of them because of cardiac events. Fourteen patients had a myocardial infarction and 19 patients developed angina pectoris. Sensitivity and specificity (0.75 and 0.67) of troponin T rapid bedside assay for MACE (angina pectoris, MI, cardiac death) was lower compared to studies in patients with normal renal function. Correlation between troponin elevation and late outcome was low or absent. CONCLUSION: Patients on chronic intermittent hemodialysis frequently present with elevated TnT and TnI levels which cannot be used as predictors of acute and chronic cardiac events. Rapid bedside assays have a lower specificity than quantitative assays.

Adult↗