Pascual-Figal Domingo A, Manzano-Fernández Sergio, Pastor Francisco, Garrido Iris P, Casas Teresa, Sánchez Mas Jesús, Ansaldo Pilar, Martínez Pedro, Valdés Mariano
Unidad de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, Murcia, España.
Rev Esp Cardiol. 2008 Jul;61(7):678-86.
The usefulness of prolonged troponin-T (TnT) monitoring in outpatients with nonischemic heart failure (HF) is not clear. The aim of this study was to investigate the incidence, prognostic value and determinants of a raised TnT level.
The study involved 80 outpatients (age 56+/-14 years, 69% male) with chronic stable HF (mean left ventricular ejection fraction 24+/-9%; 51 in New York Heart Association class II and 29 in class III) of non-ischemic origin, as confirmed with coronary angiography. The TnT level was measured at study entry and at every outpatient visit (median interval, 3.1 months; interquartile range [IQR], 1.8-5.0 months) in a follow-up period of 22.2+/-10.6 months. Patients were TnT+ if the level was measurable (i.e., >0.01 ng/mL).
At study entry, 7 (9%) patients were TnT+. By 5 years, the cumulative incidence had reached 53%, and the median TnT level was 0.059 ng/mL (IQR, 0.023-0.100 ng/mL; range, 0.013-0.500 ng/mL). Beta-blocker therapy was associated with a reduction in incidence (hazard ratio [HR]=0.220; 95% confidence interval [CI], 0.089-0.540; P=.001) while the incidence increased with the N-terminal probrain natriuretic peptide (NT-proBNP) level (HR=1.005; 95% CI, 1.001-1.010; P=0.021). During follow-up, 14 (17.5%) patients had a cardiac event (i.e., 9 cardiac deaths and 5 urgent transplants); these occurred in 12 (50%) of the 24 TnT+ patients vs. 2 (3.6%) of the 56 TnT- patients (P< .001). After adjustment, Cox multivariate analysis showed that being TnT+ was a predictor of an adverse event (HR per 0.01 ng/mL=1.359; 95% CI, 1.037-1.782; P=.026), independently of the NT-proBNP level (HR per 500 pg/mL=1.057; 95% CI, 1.023-1.092; P=.001).
A measurable TnT level was frequently observed during clinical monitoring of outpatients with non-ischemic HF and indicated a poor prognosis, even when the level was low.
非缺血性心力衰竭（HF）门诊患者长期监测肌钙蛋白T（TnT）的作用尚不清楚。本研究旨在调查TnT水平升高的发生率、预后价值及相关决定因素。
本研究纳入80例非缺血性慢性稳定HF门诊患者（年龄56±14岁，69%为男性），经冠状动脉造影证实。在研究入组时及随访期22.2±10.6个月的每次门诊就诊时（中位间隔时间3.1个月；四分位数间距[IQR]，1.8 - 5.0个月）测量TnT水平。若TnT水平可测（即>0.01 ng/mL），则患者为TnT阳性。
研究入组时，7例（9%）患者TnT阳性。至5年时，累积发生率达53%，TnT水平中位数为为0.059 ng/mL（IQR，0.023 - 0.100 ng/mL；范围，0.013 - 0.500 ng/mL）。β受体阻滞剂治疗与发生率降低相关（风险比[HR]=0.220；95%置信区间[CI]，0.089 - 0.540；P = 0.001），而发生率随N末端脑钠肽前体（NT-proBNP）水平升高而增加（HR = 1.005；95% CI，1.001 - 1.010；P = 0.021）。随访期间，14例（17.5%）患者发生心脏事件（即9例心源性死亡和5例紧急移植）；这些事件发生在24例TnT阳性患者中的12例（50%），而56例TnT阴性患者中的2例（3.6%）（P < 0.001）。调整后，Cox多因素分析显示TnT阳性是不良事件的预测因素（每0.01 ng/mL的HR = 1.359；95% CI，1.037 - 1.782；P = 0.026），独立于NT-proBNP水平（每500 pg/mL的HR = 1.057；95% CI，1.023 - 1.092；P = 0.001）。
在非缺血性HF门诊患者的临床监测中经常观察到可测的TnT水平，即使水平较低也提示预后不良。
