Chow Grant V, Hirsch Glenn A, Spragg David D, Cai Jennifer X, Cheng Alan, Ziegelstein Roy C, Marine Joseph E
From Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Medicine (Baltimore). 2010 May;89(3):141-148. doi: 10.1097/MD.0b013e3181dddb3b.
Although cardiac troponin I (cTnI) elevation in patients presenting to the hospital with supraventricular tachycardia (SVT) is well recognized, the prevalence, predictors, and prognostic significance of cTnI elevation associated with SVT presentation are not known. We screened records of all patients presenting to 2 hospitals over a 4-year period with the diagnosis of SVT confirmed by 12-lead electrocardiogram, and who had at least 1 measured cTnI level and at least 1 year of follow-up after discharge. The primary endpoint was the occurrence of 1 of the following outcomes: death, myocardial infarction, or cardiovascular rehospitalization. Seventy-eight patients met the study criteria (54% female; mean age, 62.2 +/- 15.8 yr), and 29 patients (37.2%) had an elevated cTnI level of > or =0.06 ng/mL (range, 0.06-7.78 ng/mL). Univariate predictors of elevated cTnI included left ventricular ejection fraction (LVEF) <50%, renal dysfunction, ST-segment depression or left bundle branch block on the electrocardiogram, and moderate or severe regurgitation of any cardiac valve. Predictors of elevated cTnI after multivariate analysis included peak heart rate during SVT (per 15 bpm) (odds ratio [OR], 1.58; 95% confidence interval [CI], 1.01-2.46; p = 0.04) and LVEF <50% (OR, 6.12; 95% CI, 1.40-26.7; p = 0.02). After multivariable adjustment, the presence of elevated cTnI with SVT was associated with increased risk of the primary endpoint of death, myocardial infarction, or cardiovascular rehospitalization (hazard ratio [HR], 3.67; 95% CI, 1.22-11.1; p = 0.02). Mild elevation of cTnI is common in patients presenting to the hospital with SVT, and is associated with increased risk of future cardiovascular events. Further study is needed to determine the mechanisms of SVT-related cTnI elevation and its association with elevated cardiovascular risk.
尽管因室上性心动过速（SVT）入院的患者中肌钙蛋白I（cTnI）升高已广为人知，但与SVT发作相关的cTnI升高的患病率、预测因素及预后意义尚不清楚。我们筛查了4年间两所医院所有因12导联心电图确诊为SVT、至少有1次cTnI测量值且出院后至少随访1年的患者记录。主要终点是出现以下结局之一：死亡、心肌梗死或心血管疾病再住院。78例患者符合研究标准（54%为女性；平均年龄62.2±15.8岁），29例患者（37.2%）cTnI水平升高≥0.06 ng/mL（范围0.06 - 7.78 ng/mL）。cTnI升高的单因素预测因素包括左心室射血分数（LVEF）<50%、肾功能不全、心电图ST段压低或左束支传导阻滞以及任何心脏瓣膜中度或重度反流。多因素分析后cTnI升高的预测因素包括SVT期间的心率峰值（每15次心跳/分钟）（比值比[OR]，1.58；95%置信区间[CI]，1.01 - 2.46；p = 0.04）和LVEF<50%（OR，6.12；95%CI，1.40 - 26.7；p = 0.02）。经过多变量调整后，SVT伴cTnI升高与死亡、心肌梗死或心血管疾病再住院的主要终点风险增加相关（风险比[HR]，3.67；95%CI，1.22 - 11.1；p = 0.02）。cTnI轻度升高在因SVT入院的患者中很常见，且与未来心血管事件风险增加相关。需要进一步研究以确定SVT相关cTnI升高的机制及其与心血管风险升高的关联。
