Ishii Junnichi, Cui Wei, Kitagawa Fumihiko, Kuno Takahiro, Nakamura Yuu, Naruse Hiroyuki, Mori Yoshihisa, Ishikawa Takashi, Nagamura Youichi, Kondo Takeshi, Oshima Hisaji, Nomura Masanori, Ezaki Kouji, Hishida Hitoshi
Division of Critical Care, Fujita Health University Graduate School of Health Sciences, Toyoake 470-1192, Japan.
Clin Chem. 2003 Dec;49(12):2020-6. doi: 10.1373/clinchem.2003.021311.
Recent studies have suggested that cardiac troponin T (cTnT) and troponin I may detect ongoing myocardial damage involved in the progression of chronic heart failure (CHF). This study was prospectively designed to examine whether the combination of cTnT, a marker for ongoing myocardial damage, and B-type natriuretic peptide (BNP), a marker for left ventricular overload, would effectively stratify patients with CHF after initiation of treatment.
We measured serum cTnT, plasma BNP, and left ventricular ejection fraction (LVEF) on admission for worsening CHF [New York Heart Association (NYHA) functional class III to IV] and 2 months after initiation of treatment to stabilize CHF (n = 100; mean age, 68 years).
Mean (SD) concentrations of cTnT [0.023 (0.066) vs 0.063 (0.20) micro g/L] and BNP [249 (276) vs 753 (598) ng/L], percentage increased cTnT (>0.01 micro g/L; 35% vs 60%), NYHA functional class [2.5 (0.6) vs 3.5 (5)], and LVEF [43 (13)% vs 36 (12)%] were significantly (P <0.01) improved 2 months after treatment compared with admission. During a mean follow-up of 391 days, there were 44 cardiac events, including 12 cardiac deaths and 32 readmissions for worsening CHF. On a stepwise Cox regression analysis, increased cTnT and BNP were independent predictors of cardiac events (P <0.001). cTnT >0.01 micro g/L and/or BNP >160 ng/L 2 months after initiation of treatment were associated with increased cardiac mortality and morbidity rates.
The combination of cTnT and BNP measurements after initiation of treatment may be highly effective for risk stratification in patients with CHF.
近期研究表明，心肌肌钙蛋白T（cTnT）和肌钙蛋白I可能检测出慢性心力衰竭（CHF）进展过程中正在发生的心肌损伤。本研究旨在前瞻性地检验正在发生的心肌损伤标志物cTnT与左心室负荷标志物B型利钠肽（BNP）的联合检测能否在治疗开始后对CHF患者进行有效分层。
我们对因CHF恶化（纽约心脏协会[NYHA]心功能分级III至IV级）入院时以及开始治疗以稳定CHF后2个月的患者（n = 100；平均年龄68岁）测定了血清cTnT、血浆BNP和左心室射血分数（LVEF）。
与入院时相比，治疗2个月后cTnT的平均（标准差）浓度[0.023（0.066）对0.063（0.20）μg/L]、BNP的平均（标准差）浓度[249（276）对753（598）ng/L]、cTnT升高的百分比（>0.01μg/L；35%对60%）、NYHA心功能分级[2.5（0.6）对3.5（5）]以及LVEF[43（13）%对36（12）%]均有显著改善（P <0.01）。在平均391天的随访期间，发生了44次心脏事件，包括12例心源性死亡和32例因CHF恶化再次入院。在逐步Cox回归分析中，cTnT和BNP升高是心脏事件的独立预测因素（P <0.001）。治疗开始后2个月时cTnT>0.01μg/L和/或BNP>160 ng/L与心源性死亡率和发病率增加相关。
治疗开始后联合检测cTnT和BNP可能对CHF患者进行风险分层非常有效。
