高敏心肌肌钙蛋白 I 在射血分数降低的心力衰竭患者中的预后价值。

Prognostic role of highly sensitive cardiac troponin I in patients with systolic heart failure.

机构信息

Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan.

出版信息

Am Heart J. 2010 Jan;159(1):63-7. doi: 10.1016/j.ahj.2009.10.022.

DOI:10.1016/j.ahj.2009.10.022

PMID:20102868

Abstract

BACKGROUND

Cardiac troponin T (cTnT) and cardiac troponin I (cTnI) are useful biomarkers in patients with chronic heart failure (CHF). However, the clinical use has limitations due to the low sensitivity of a conventional commercial assay system. Recently, a high sensitive-cTnI (hs-cTnI) commercial assay has become available.

METHODS

To compare the prognostic value of cTnT and hs-cTnI, we measured hemodynamic parameters and serum levels of cTnT, hs-cTnI and N-terminal pro-brain natriuretic peptide (NT-proBNP)in 258 consecutive CHF patients and then followed these patients for a mean period of 2.6 years. In both assays of cTnT and hs-cTnI, the lowest concentration at which the coeffi cient of variation was < or =10% were 0.03 ng/mL, respectively. Therefore, in the present study, an elevated cTnT or cTnI test was defined as a level of > or =0.03 ng/mL.

RESULTS

During long-term follow up, there were 20 cardiac deaths. In 258 CHF patients, serum cTnT were elevated (> or =0.03 ng/mL) in 32 patients (12%) and serum hs-cTnI was elevated (> or =0.03 ng/mL) in 112 patients (43%). On stepwise multivariate analyses, high plasma NT-proBNP (> or =627 pg/mL, P = .0063) and hs-cTnI (> or =0.03 ng/mL) (P = .016) were independent significant prognostic predictors but cTnT (> or =0.03 ng/mL) was not. The hazard ratio for mortality of patients with high plasma NT-proBNP (> or =627 pg/mL) and hs-cTnI (> or =0.03 ng/mL) was 5.74 (95% CI, 2.33-14.28, P < .0001) compared to that of those with low NT-proBNP (<627 pg/mL) or hs-cTnI (<0.03 ng/mL).

CONCLUSIONS

These findings indicate that a high plasma concentration of hs-cTnI is an independent and useful prognostic predictor in patients with CHF.

摘要

背景

心肌肌钙蛋白 T（cTnT）和心肌肌钙蛋白 I（cTnI）是慢性心力衰竭（CHF）患者有用的生物标志物。然而，由于常规商业检测系统的灵敏度低，其临床应用受到限制。最近，一种高敏肌钙蛋白 I（hs-cTnI）商业检测系统已经问世。

方法

为了比较 cTnT 和 hs-cTnI 的预后价值，我们测量了 258 例连续 CHF 患者的血流动力学参数和血清 cTnT、hs-cTnI 和 N 末端脑利钠肽前体（NT-proBNP）水平，然后对这些患者进行了平均 2.6 年的随访。在 cTnT 和 hs-cTnI 的两种检测中，变异系数<或=10%的最低浓度分别为 0.03ng/ml。因此，在本研究中，cTnT 或 cTnI 检测升高定义为>或=0.03ng/ml。

结果

在长期随访中，有 20 例心脏死亡。在 258 例 CHF 患者中，32 例（12%）血清 cTnT 升高（>或=0.03ng/ml），112 例（43%）血清 hs-cTnI 升高（>或=0.03ng/ml）。逐步多元分析显示，高血浆 NT-proBNP（>或=627pg/ml，P=0.0063）和 hs-cTnI（>或=0.03ng/ml）（P=0.016）是独立的显著预后预测因子，但 cTnT（>或=0.03ng/ml）不是。高血浆 NT-proBNP（>或=627pg/ml）和 hs-cTnI（>或=0.03ng/ml）患者的死亡风险比为 5.74（95%可信区间，2.33-14.28，P<0.0001），而低 NT-proBNP（<627pg/ml）或 hs-cTnI（<0.03ng/ml）患者的死亡风险比为 1。