Latini Roberto, Masson Serge, Anand Inder S, Missov Emil, Carlson Marjorie, Vago Tarcisio, Angelici Laura, Barlera Simona, Parrinello Giovanni, Maggioni Aldo P, Tognoni Gianni, Cohn Jay N
Department of Cardiovascular Research, Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
Circulation. 2007 Sep 11;116(11):1242-9. doi: 10.1161/CIRCULATIONAHA.106.655076. Epub 2007 Aug 13.
Circulating cardiac troponin T, a marker of cardiomyocyte injury, predicts adverse outcome in patients with heart failure (HF) but is detectable in only a small fraction of those with chronic stable HF. We assessed the prognostic value of circulating cardiac troponin T in patients with stable chronic HF with a traditional (cTnT) and a new precommercial highly sensitive assay (hsTnT).
Plasma troponin T was measured in 4053 patients with chronic HF enrolled in the Valsartan Heart Failure Trial (Val-HeFT). Troponin T was detectable in 10.4% of the population with the cTnT assay (detection limit < or = 0.01 ng/mL) compared with 92.0% with the new hsTnT assay (< or = 0.001 ng/mL). Patients with cTnT elevation or with hsTnT above the median (0.012 ng/mL) had more severe HF and worse outcome. In Cox proportional hazards models adjusting for clinical risk factors, cTnT was associated with death (780 events; hazard ratio=2.08; 95% confidence interval, 1.72 to 2.52; P<0.0001) and first hospitalization for HF (655 events; hazard ratio=1.55; 95% confidence interval, 1.25 to 1.93; P<0.0001). HsTnT was associated with the risk of death in unadjusted analysis for deciles of concentrations and in multivariable models (hazard ratio=1.05; 95% confidence interval, 1.04 to 1.07 for increments of 0.01 ng/mL; P<0.0001). Addition of hsTnT to well-calibrated models adjusted for clinical risk factors, with or without brain natriuretic peptide, significantly improved prognostic discrimination (C-index, P<0.0001 for both outcomes).
In this large population of patients with HF, detectable cTnT predicts adverse outcomes in chronic HF. By the highly sensitive assay, troponin T retains a prognostic value at previously undetectable concentrations.
循环心肌肌钙蛋白T是心肌细胞损伤的标志物，可预测心力衰竭（HF）患者的不良预后，但仅在一小部分慢性稳定HF患者中可检测到。我们使用传统检测方法（cTnT）和一种新的商业前高敏检测方法（hsTnT）评估了循环心肌肌钙蛋白T在稳定慢性HF患者中的预后价值。
在缬沙坦心力衰竭试验（Val-HeFT）中纳入的4053例慢性HF患者中测量血浆肌钙蛋白T。采用cTnT检测方法（检测限≤0.01 ng/mL）时，10.4%的患者可检测到肌钙蛋白T，而采用新的hsTnT检测方法（≤0.001 ng/mL）时，这一比例为92.0%。cTnT升高或hsTnT高于中位数（0.012 ng/mL）的患者HF更严重，预后更差。在调整临床危险因素的Cox比例风险模型中，cTnT与死亡（780例事件；风险比=2.08；95%置信区间，1.72至2.52；P<0.0001）和首次因HF住院（655例事件；风险比=1.55；95%置信区间，1.25至1.93；P<0.0001）相关。在浓度十分位数的未调整分析和多变量模型中，hsTnT与死亡风险相关（风险比=1.05；0.01 ng/mL增量的95%置信区间，1.04至1.07；P<0.0001）。将hsTnT添加到调整了临床危险因素的校准良好的模型中，无论是否添加脑钠肽，均显著改善了预后判别能力（两种结局的C指数，P均<0.0001）。
在这一大量HF患者群体中，可检测到的cTnT可预测慢性HF的不良预后。通过高敏检测方法，肌钙蛋白T在以前无法检测到的浓度下仍保留预后价值。
