Koide Kimi, Yoshikawa Tsutomu, Nagatomo Yuji, Kohsaka Shun, Anzai Toshihisa, Meguro Tomomi, Ogawa Satoshi
Cardiology Division, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
Heart Vessels. 2010 May;25(3):217-22. doi: 10.1007/s00380-009-1194-6. Epub 2010 May 29.
Persistent elevation of cardiac troponin T (cTnT) predicts an adverse clinical outcome in patients with chronic heart failure (HF), but the underlying mechanisms remain to be determined. We investigated the association between predischarge cTnT elevation and coexistent pathophysiology in patients with decompensated HF. Plasma cTnT levels were determined before discharge in 170 patients with decompensated HF. We divided the patients into a group that was positive for cTnT [cTnT(+) group, n = 40] and a group that was negative for cTnT [cTnT(-) group, n = 130]. Multivariate analysis showed that use of beta-blocker therapy (odds ratio [OR] = 0.236, P = 0.003), an elevated high-sensitivity C-reactive protein (hsCRP) level (OR = 3.731, P = 0.006), a high brain natriuretic peptide (BNP) level (OR = 3.570, P = 0.007), diabetes (OR = 3.090, P = 0.018), and anemia (OR = 2.330, P = 0.047) were independently associated with cTnT positivity. During a mean follow-up period of 441 days after discharge, total mortality (P < 0.001), cardiac death (P < 0.001), and exacerbation of HF requiring hospitalization (P = 0.007) were all more common in the cTnT(+) group than in the cTnT(-) group. Cox proportional hazards analysis showed that cTnT positivity was an independent predictor of total mortality (hazard ratio = 5.008, P = 0.004) in an age- and gender-matched model. Elevation of cTnT during convalescence was associated with lack of beta-blocker therapy, a high hsCRP level at discharge, a high BNP level at discharge, diabetes, and anemia, and a worse clinical outcome in patients with decompensated HF.
心肌肌钙蛋白T（cTnT）持续升高预示着慢性心力衰竭（HF）患者临床预后不良，但其潜在机制仍有待确定。我们研究了失代偿性HF患者出院前cTnT升高与并存病理生理学之间的关联。测定了170例失代偿性HF患者出院前的血浆cTnT水平。我们将患者分为cTnT阳性组[cTnT(+)组，n = 40]和cTnT阴性组[cTnT(-)组，n = 130]。多因素分析显示，使用β受体阻滞剂治疗（比值比[OR]=0.236，P = 0.003）、高敏C反应蛋白（hsCRP）水平升高（OR = 3.731，P = 0.006）、高脑钠肽（BNP）水平（OR = 3.570，P = 0.007）、糖尿病（OR = 3.090，P = 0.018）和贫血（OR = 2.330，P = 0.047）与cTnT阳性独立相关。在出院后平均441天的随访期内，cTnT(+)组的总死亡率（P < 0.001）、心源性死亡（P < 0.001）和需要住院治疗的HF加重（P = 0.007）均比cTnT(-)组更常见。Cox比例风险分析显示，在年龄和性别匹配的模型中，cTnT阳性是总死亡率的独立预测因素（风险比=5.008，P = 0.004）。恢复期cTnT升高与未使用β受体阻滞剂治疗、出院时hsCRP水平高、出院时BNP水平高、糖尿病和贫血有关，且与失代偿性HF患者更差的临床结局相关。
