高敏肌钙蛋白 T 和 N 末端 B 型利钠肽原独立预测先天性心脏病成人的生存和心脏相关事件。

High-sensitive troponin T and N-terminal pro-B-type natriuretic peptide independently predict survival and cardiac-related events in adults with congenital heart disease.

机构信息

Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, 80636 Munich, Germany.

Institute of Preventive Pediatrics, Technische Universität München, Georg-Brauchle-Ring 60/62, 80992 München, Germany.

出版信息

Eur J Cardiovasc Nurs. 2024 Jan 12;23(1):55-61. doi: 10.1093/eurjcn/zvad032.

DOI:10.1093/eurjcn/zvad032

PMID:36883916

Abstract

AIMS

High-sensitive troponin T (hs-TnT), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and C-reactive protein (CRP) are established prognostic biomarkers for cardiovascular (CV) morbidity and mortality and frequently used in symptomatic and/or hospitalized adults with congenital heart disease (ACHD). Their prognostic value in clinically stable ACHD has not yet been well established. This study investigates the predictive value of hs-TnT, NT-proBNP, and CRP for survival and CV events in stable ACHD.

METHODS AND RESULTS

In this prospective cohort study, 495 outpatient ACHD (43.9 ± 10.0 years, 49.1% female) underwent venous blood sampling including hs-TnT, NT-proBNP, and CRP. Patients were followed up for survival status and the occurrence of CV events. Survival analyses were performed with Cox proportional hazards regression analysis and Kaplan-Meier curves. During a mean follow-up of 2.8 ± 1.0 years, 53 patients (10.7%) died or reached a cardiac-related endpoint including sustained ventricular tachycardia, hospitalization with cardiac decompensation, ablation, interventional catheterization, pacer implantation, or cardiac surgery. Multivariable Cox regression revealed hs-TnT (P = 0.005) and NT-proBNP (P = 0.018) as independent predictors of death or cardiac-related events in stable ACHD, whilst the prognostic value of CRP vanished after multivariable adjustment (P = 0.057). Receiver-operator characteristic curve analysis identified cut-off values for event-free survival of hs-TnT ≤9 ng/L and NT-proBNP ≤200 ng/L. Patients with both increased biomarkers had a 7.7-fold (confidence interval 3.57-16.40, P < 0.001) higher risk for death and cardiac-related events compared with patients without elevated blood values.

CONCLUSION

Subclinical values of hs-TnT and NT-proBNP are a useful, simple, and independent prognostic tool for adverse cardiac events and survival in stable outpatient ACHD.

REGISTRATION

German Clinical Trial Registry DRKS00015248.

摘要

目的

高敏肌钙蛋白 T（hs-TnT）、氨基末端 B 型利钠肽前体（NT-proBNP）和 C 反应蛋白（CRP）是心血管（CV）发病率和死亡率的既定预后生物标志物，常用于有症状和/或住院的先天性心脏病（ACHD）成人。它们在临床稳定的 ACHD 中的预后价值尚未得到很好的确定。本研究旨在探讨 hs-TnT、NT-proBNP 和 CRP 对稳定型 ACHD 患者生存和 CV 事件的预测价值。

方法和结果

在这项前瞻性队列研究中，495 名门诊 ACHD 患者（43.9 ± 10.0 岁，49.1%为女性）接受了静脉血样采集，包括 hs-TnT、NT-proBNP 和 CRP。患者接受了生存状况和 CV 事件的随访。使用 Cox 比例风险回归分析和 Kaplan-Meier 曲线进行生存分析。在平均 2.8 ± 1.0 年的随访期间，53 名患者（10.7%）死亡或达到心脏相关终点，包括持续性室性心动过速、心脏失代偿住院、消融、介入导管插入术、起搏器植入或心脏手术。多变量 Cox 回归显示，hs-TnT（P = 0.005）和 NT-proBNP（P = 0.018）是稳定型 ACHD 患者死亡或心脏相关事件的独立预测因子，而 CRP 的预后价值在多变量调整后消失（P = 0.057）。受试者工作特征曲线分析确定了 hs-TnT≤9ng/L 和 NT-proBNP≤200ng/L 的无事件生存的截断值。与无升高生物标志物的患者相比，hs-TnT 和 NT-proBNP 同时升高的患者死亡和心脏相关事件的风险增加了 7.7 倍（置信区间 3.57-16.40，P<0.001）。