Panteghini Mauro, Bonetti Graziella, Pagani Franca, Stefini Francesca, Giubbini Raffaele, Cuccia Claudio
Dipartimento di Scienze Cliniche Luigi Sacco, Facoltà di Medicina e Chirurgia-Polo di Vialba, Università degli Studi di Milano, Milan, Italy.
Clin Chem Lab Med. 2005;43(8):848-54. doi: 10.1515/CCLM.2005.143.
Few studies have evaluated cardiac troponin I (cTnI) as a marker for infarct size and left ventricular (LV) dysfunction. Here we investigated the ability of a single-point cTnI, measured with a second-generation assay (Access AccuTnI), to estimate infarct size and assess LV function in patients with a first myocardial infarction (AMI). cTnI measurements were performed 12 and 48 h after admission in 63 consecutive AMI patients. LV function was evaluated by gated single-photon emission computed tomography (SPECT) and infarct size was estimated by CK-MB peak and SPECT myocardial perfusion. LV function and infarct size were evaluated by SPECT before hospital discharge. SPECT was also repeated 3 months later. Significant correlations (p<0.001) were found between cTnI at 12 and 48 h and both the peak CK-MB (r=0.61 and r=0.82, respectively) and the perfusion defect size at SPECT (r=0.55 and r=0.61, respectively). cTnI at 12 and 48 h were inversely related (p<0.001) to LV ejection fraction (LVEF) assessed both early (r=-0.45 and r=-0.57, respectively) and 3 months after AMI (r=-0.51 and r=-0.69, respectively). cTnI >14.8 microg/L at 48 h predicted an LVEF <40% at 3 months with a sensitivity of 100% [95% confidence interval (CI) 73.5-100%], specificity of 65% (CI 49-79%), and a negative predictive value of 100%. Our findings demonstrate that a single cTnI measurement 48 h after admission is useful for ruling out impaired LV function in a routine clinical setting.
很少有研究评估心肌肌钙蛋白I（cTnI）作为梗死面积和左心室（LV）功能障碍的标志物。在此，我们研究了采用第二代检测方法（Access AccuTnI）测量的单点cTnI在首次心肌梗死（AMI）患者中估计梗死面积和评估左心室功能的能力。对63例连续的AMI患者在入院后12小时和48小时进行cTnI测量。通过门控单光子发射计算机断层扫描（SPECT）评估左心室功能，并通过CK-MB峰值和SPECT心肌灌注估计梗死面积。在出院前通过SPECT评估左心室功能和梗死面积。3个月后也重复进行SPECT检查。发现在12小时和48小时时的cTnI与CK-MB峰值（分别为r = 0.61和r = 0.82）以及SPECT时的灌注缺损大小（分别为r = 0.55和r = 0.61）之间存在显著相关性（p<0.001）。12小时和48小时时的cTnI与AMI早期（分别为r = -0.45和r = -0.57）以及AMI后3个月（分别为r = -0.51和r = -0.69）评估的左心室射血分数（LVEF）呈负相关（p<0.001）。48小时时cTnI>14.8μg/L预测3个月时LVEF<40%，敏感性为100% [95%置信区间（CI）73.5 - 100%]，特异性为65%（CI 49 - 79%），阴性预测值为100%。我们的研究结果表明，入院后48小时进行单次cTnI测量有助于在常规临床环境中排除左心室功能受损。
