Ammann Peter, Maggiorini Marco, Bertel Osmund, Haenseler Edgar, Joller-Jemelka Helen I, Oechslin Erwin, Minder Elisabeth I, Rickli Hans, Fehr Thomas
Division of Cardiology, Triemli Hospital, Zurich, Switzerland.
J Am Coll Cardiol. 2003 Jun 4;41(11):2004-9. doi: 10.1016/s0735-1097(03)00421-2.
We sought to assess the mechanism and prognostic value of elevated troponins in patients without acute coronary syndromes (ACS).
Cardiac troponins are used as specific markers for the diagnosis of ACS. Recent studies reported a considerable number of critically ill patients without ACS as being troponin-positive, especially patients with sepsis, pulmonary embolism, renal failure, and stroke.
We analyzed 58 consecutive, critically ill patients admitted for reasons other than ACS, according to their troponin status. Thirty-day mortality, left ventricular ejection fraction (LVEF), and a panel of inflammatory cytokines were compared between troponin-positive and troponin-negative patients. Relevant coronary artery disease was excluded either by stress echocardiography or autopsy.
Of the 58 critically ill patients, 32 (55%) without evidence of ACS were troponin-positive. Positive troponin levels were associated with higher mortality (22.4% vs. 5.2%, p < 0.018) and a lower LVEF (p = 0.0006). Troponin-positive patients had significantly higher median levels of tumor necrosis factor (TNF)-alpha, its soluble receptor, and interleukin (IL)-6. A subgroup of 10 aplastic patients was troponin-negative at study entry. Three became troponin-positive during leukocyte recovery and subsequently died, whereas all the others stayed troponin-negative and survived. Flow-limiting coronary artery disease was not demonstrable at autopsy or stress echocardiography in 72% of troponin-positive patients.
Elevated troponin is a mortality risk factor for medical intensive care patients admitted for reasons other than ACS. It is associated with decreased left ventricular function and higher levels of TNF-alpha and IL-6.
我们试图评估肌钙蛋白升高在无急性冠脉综合征（ACS）患者中的机制及预后价值。
心肌肌钙蛋白用作诊断ACS的特异性标志物。近期研究报道，相当数量无ACS的危重症患者肌钙蛋白呈阳性，尤其是脓毒症、肺栓塞、肾衰竭及中风患者。
我们根据肌钙蛋白状态分析了58例因非ACS原因入院的连续危重症患者。比较了肌钙蛋白阳性和阴性患者的30天死亡率、左心室射血分数（LVEF）及一组炎性细胞因子。通过负荷超声心动图或尸检排除相关冠状动脉疾病。
58例危重症患者中，32例（55%）无ACS证据但肌钙蛋白呈阳性。肌钙蛋白阳性与较高死亡率（22.4%对5.2%，p<0.018）及较低LVEF（p=0.0006）相关。肌钙蛋白阳性患者的肿瘤坏死因子（TNF）-α、其可溶性受体及白细胞介素（IL）-6的中位数水平显著更高。10例再生障碍性贫血患者在研究入组时肌钙蛋白呈阴性。3例在白细胞恢复过程中肌钙蛋白转为阳性，随后死亡，而其他所有患者肌钙蛋白仍为阴性并存活。72%的肌钙蛋白阳性患者在尸检或负荷超声心动图中未显示有血流限制性冠状动脉疾病。
肌钙蛋白升高是因非ACS原因入院的医学重症监护患者的死亡风险因素。它与左心室功能降低及TNF-α和IL-6水平升高相关。
