Ishii Junnichi, Nomura Masanori, Nakamura Yuu, Naruse Hiroyuki, Mori Yoshihisa, Ishikawa Takashi, Ando Toshikazu, Kurokawa Hiroshi, Kondo Takeshi, Nagamura Youichi, Ezaki Kouji, Hishida Hitoshi
Division of Critical Care, Graduate School of Health Sciences, Fujita Health University, Toyoake, Japan.
Am J Cardiol. 2002 Mar 15;89(6):691-5. doi: 10.1016/s0002-9149(01)02341-4.
We prospectively evaluated whether the combination of admission measurements of a marker for myocardial cell injury and a marker for left ventricular overload would effectively risk stratify patients with acutely decompensated heart failure. We measured serum concentrations of cardiac troponin T (cTnT) using a second-generation assay, as well as serum cardiac troponin I (cTnI) and plasma atrial and brain natriuretic peptide (BNP) concentrations on admission in 98 consecutive patients hospitalized for worsening chronic heart failure (mean age 69 years; 5 patients were in New York Heart Association functional class II, 35 were in class III, and 58 patients were in class IV). During a mean follow-up period of 451 days, there were 37 cardiac events, including 21 cardiac deaths (14 in-hospital deaths) and 16 readmissions for worsening heart failure. In a stepwise Cox regression analysis, including these biochemical markers, age, sex, functional class, and left ventricular ejection fraction, cTnT, and BNP were found to be significantly independent predictors of both cardiac death (p <0.05) and cardiac events (p <0.01). A cTnT >0.033 microg/L and/or a BNP >440 pg/ml on admission was correlated with an incremental increase in in-hospital cardiac mortality, overall cardiac mortality, and cardiac event rate. Kaplan-Meier analysis revealed that this combination could reliably stratify the patients into low-, intermediate-, and high-risk groups for cardiac events. Measuring the combination of admission concentrations of cTnT and BNP may be a highly effective means of risk stratification of patients hospitalized for worsening chronic heart failure.
我们前瞻性地评估了心肌细胞损伤标志物与左心室负荷过重标志物的入院检测指标联合使用是否能有效地对急性失代偿性心力衰竭患者进行风险分层。我们使用第二代检测方法测定了98例因慢性心力衰竭恶化而住院的连续患者入院时的血清心肌肌钙蛋白T（cTnT）浓度以及血清心肌肌钙蛋白I（cTnI）和血浆心房利钠肽及脑钠肽（BNP）浓度（平均年龄69岁；5例为纽约心脏协会心功能II级，35例为III级，58例为IV级）。在平均451天的随访期内，发生了37次心脏事件，包括21例心源性死亡（14例院内死亡）和16例因心力衰竭恶化再次入院。在逐步Cox回归分析中，纳入这些生化标志物、年龄、性别、心功能分级和左心室射血分数后，发现cTnT和BNP是心源性死亡（p<0.05）和心脏事件（p<0.01）的显著独立预测因素。入院时cTnT>0.033μg/L和/或BNP>440pg/ml与院内心源性死亡率、总体心源性死亡率和心脏事件发生率的增加相关。Kaplan-Meier分析显示，这种联合检测能够可靠地将患者分为心脏事件的低、中、高风险组。测定入院时cTnT和BNP浓度的联合指标可能是对因慢性心力衰竭恶化而住院的患者进行风险分层的一种高效方法。
