连续测量心肌肌钙蛋白T水平以预测失代偿性心力衰竭的临床事件

Serial measure of cardiac troponin T levels for prediction of clinical events in decompensated heart failure.

作者信息

Del Carlo Carlos H, Pereira-Barretto Antonio C, Cassaro-Strunz Célia, Latorre Maria Do Rosário D O, Ramires José A Franchini

机构信息

Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar 44, São Paulo, SP, Brazil.

出版信息

J Card Fail. 2004 Feb;10(1):43-8. doi: 10.1016/s1071-9164(03)00594-3.

DOI:10.1016/s1071-9164(03)00594-3

PMID:14966774

Abstract

BACKGROUND

This study determined whether serial determinations of cardiac troponin T (cTnT) in decompensated heart failure (HF) are predictive of clinical events (death, need for readmission for new episode of HF decompensation, or both) during 1 year of follow-up.

METHODS AND RESULTS

Sixty-two patients with decompensated HF were enrolled in this cohort. The first measurement of cTnT (cTnT1) was from a blood sample drawn within 4 days of hospital admission; the second measurement (cTnT2) was on blood obtained 7 days later. Forty-nine clinical events (16 deaths, 10 readmissions, 23 combined readmission and deaths) occurred during the follow-up. The independent predictors of clinical events were: cTnT1>.020 ng/mL (P<.050), cTnT2>.020 ng/mL (P<.050), and serum sodium<135 mEq/L (P<.050). Based on levels of cTnT1 and cTnT2>.020 ng/mL (+) or </=0.020 ng/mL(-), patients were divided into 2 groups: group 1 (cTnT1-, cTnT2- or cTnT1+, cTnT2-), group 2 (cTnT1-, cTnT2+ or cTnT1+, cTnT2+). Group 2 patients had higher rates of death (45.0% versus 71.4%, P<.050), hospital readmission (35.0% versus 61.9%, P<.050), and clinical events (55.0% versus 90.5%, P<.010) than group 1 patients.

CONCLUSIONS

Persistently increased cTnT levels (>.020 ng/mL) are predictive of higher rates of death and hospital readmission for decompensated HF.

摘要

背景

本研究旨在确定在失代偿性心力衰竭（HF）患者中，连续测定心肌肌钙蛋白T（cTnT）是否可预测1年随访期内的临床事件（死亡、因新的HF失代偿发作而再次入院或两者兼有）。

方法与结果

62例失代偿性HF患者纳入本队列研究。首次测定cTnT（cTnT1）来自入院4天内采集的血样；第二次测定（cTnT2）来自7天后采集的血样。随访期间发生49例临床事件（16例死亡、10例再次入院、23例再次入院合并死亡）。临床事件的独立预测因素为：cTnT1>.020 ng/mL（P<.050）、cTnT2>.020 ng/mL（P<.050）和血清钠<135 mEq/L（P<.050）。根据cTnT1和cTnT2>.020 ng/mL（+）或≤0.020 ng/mL（-）的水平，将患者分为两组：第1组（cTnT1-，cTnT2-或cTnT1+，cTnT2-），第2组（cTnT1-，cTnT2+或cTnT1+，cTnT2+）。第2组患者的死亡率（45.0%对71.4%，P<.050）、再次住院率（35.0%对61.9%，P<.050）和临床事件发生率（55.0%对90.5%，P<.010）均高于第1组患者。