Heart Failure Clinic, Mexico City, México.
Cardiol J. 2010;17(1):42-8.
The aim of this study is to determine the prevalence and prognostic value of elevated cardiac troponin (cTnT) and its association with clinical characteristics according to renal function status in patients with stable heart failure.
In a prospective observational study, 152 consecutive patients from the Heart Failure Clinic of the INCMNSZ were followed for a period of 42 months. All underwent clinical evaluation, echocardiography, and determination of body composition by electric bioimpedance to identify hypervolemia. Concentrations of cTnT were quantified by immunoassay with electrochemoluminescence and > or = 0.02 ng/mL levels were considered elevated. Also glomerular filtration rate (eGFR) was estimated using the Cockcroft-Gault equation.
Elevated cTnT was significantly associated with increased all-cause mortality in the observational period even after adjusting for eGFR < 60 mL/min/1.73 m2 and clinical findings such as hypertension, functional class, loop diuretics, angiotensin converting enzyme inhibitors, pulmonary pressure and hypervolemia in Cox regression analysis with a hazard ratio of 4.58 (95% confidence interval: 1.84-11.45).
Heart failure patients with elevated cardiac-specific troponin T are at increased risk of death independently of the presence of chronic kidney disease.
本研究旨在确定稳定心力衰竭患者根据肾功能状态，心肌肌钙蛋白（cTnT）升高的患病率和预后价值及其与临床特征的关系。
在一项前瞻性观察研究中，对 INCMNSZ 心力衰竭诊所的 152 例连续患者进行了为期 42 个月的随访。所有患者均接受临床评估、超声心动图检查和通过电阻抗法测定身体成分以确定血容量过多。通过电化学发光免疫分析法定量检测 cTnT 浓度，将 > 或 = 0.02ng/ml 水平定义为升高。同时使用 Cockcroft-Gault 方程估计肾小球滤过率（eGFR）。
即使在校正 eGFR < 60mL/min/1.73m2 以及高血压、功能分级、噻嗪类利尿剂、血管紧张素转换酶抑制剂、肺动脉压和血容量过多等临床发现后，在 Cox 回归分析中，cTnT 升高与全因死亡率显著相关，风险比为 4.58（95%置信区间：1.84-11.45）。
患有升高的心脏特异性肌钙蛋白 T 的心力衰竭患者，即使存在慢性肾脏病，死亡风险也会增加。
