Giannitsis Evangelos, Steen Henning, Kurz Kerstin, Ivandic Boris, Simon Anke C, Futterer Simon, Schild Christian, Isfort Peter, Jaffe Allan S, Katus Hugo A
Abteilung Innere Medizin III, Medizinische Klinik, Universitätsklinikum Heidelberg, Heidelberg, Germany.
J Am Coll Cardiol. 2008 Jan 22;51(3):307-14. doi: 10.1016/j.jacc.2007.09.041.
We compared single-point cardiac troponin T (cTnT) measurements with parameters from serial sampling during 96 h after acute myocardial infarction with magnetic resonance imaging measured infarct mass.
Contrast-enhanced magnetic resonance imaging (CE-MRI) allows exact quantification of myocardial infarct size. Clinically, measurement of cardiac biomarkers is a more convenient alternative.
The CE-MRI infarct mass was determined 4 days after primary percutaneous coronary intervention in 31 ST-segment elevation myocardial infarction (STEMI) and 30 non-ST-segment elevation myocardial infarction (NSTEMI) patients. All single-point, peak, and integrated area under the curve (AUC) cTnT values were plotted against CE-MRI infarct mass.
All single-point and serial cTnT values were significantly higher in STEMI than in NSTEMI (p < 0.01) patients. Except for the admission values, all single-point values on any of the first 4 days, peak cTnT and AUC cTnT were found to correlate comparably well with infarct mass. Among single-point measurements, cTnT on day 4 (cTnTD4) showed highest correlation and performed as well as peak cTnT or AUC cTnT (r = 0.66 vs. r = 0.65 vs. r = 0.69). Receiver-operator characteristic analysis demonstrated that cTnTD4 >0.84 microg/l predicted infarct mass above median as well as peak cTnT >1.57 microg/l or AUC cTnT (receiver-operator characteristic for AUC: 0.839 vs. 0.866 vs. 0.893). However, estimation of infarct mass with cTnTD4, peak cTnT, and AUC cTnT was worse in patients with NSTEMI (r = 0.36, r = 0.5, r = 0.36) than in STEMI (r = 0.75 vs. r = 0.65 vs. r = 0.76).
All single-point cTnTs, except on admission, give a good estimation of infarct size and perform as well as peak cTnT or AUC cTnT. Infarct estimation by single-point measurements, particularly cTnTD4, may gain clinical acceptance because the measurement is easy and inexpensive.
我们将急性心肌梗死后96小时内单点心肌肌钙蛋白T（cTnT）测量值与连续采样参数进行比较，并与磁共振成像测量的梗死心肌质量进行对比。
对比增强磁共振成像（CE-MRI）可精确量化心肌梗死面积。临床上，检测心脏生物标志物是一种更便捷的替代方法。
对31例ST段抬高型心肌梗死（STEMI）患者和30例非ST段抬高型心肌梗死（NSTEMI）患者在接受直接经皮冠状动脉介入治疗4天后进行CE-MRI梗死心肌质量测定。将所有单点、峰值及曲线下面积（AUC）的cTnT值与CE-MRI梗死心肌质量进行绘图分析。
STEMI患者的所有单点和连续cTnT值均显著高于NSTEMI患者（p < 0.01）。除入院时的值外，前4天中任何一天的所有单点值、cTnT峰值及AUC cTnT与梗死心肌质量的相关性均较好。在单点测量中，第4天的cTnT（cTnTD4）相关性最高，与cTnT峰值或AUC cTnT表现相当（r = 0.66 vs. r = 0.65 vs. r = 0.69）。受试者工作特征分析表明，cTnTD4>0.84μg/L预测梗死心肌质量高于中位数，与cTnT峰值>1.57μg/L或AUC cTnT相当（AUC的受试者工作特征曲线下面积：0.839 vs. 0.866 vs. 0.893）。然而，NSTEMI患者用cTnTD4、cTnT峰值和AUC cTnT估算梗死心肌质量的效果（r = 0.36，r = 0.5，r = 0.36）比STEMI患者差（r = 0.75 vs. r = 0.65 vs. r = 0.76）。
除入院时外，所有单点cTnT均能较好地估算梗死面积，与cTnT峰值或AUC cTnT表现相当。通过单点测量，尤其是cTnTD4估算梗死面积可能会被临床接受，因为该测量方法简便且成本低廉。
