肌钙蛋白 T 水平与 SPECT 心肌灌注成像检测的梗死面积。

Troponin T levels and infarct size by SPECT myocardial perfusion imaging.

机构信息

Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.

出版信息

JACC Cardiovasc Imaging. 2011 May;4(5):523-33. doi: 10.1016/j.jcmg.2011.03.010.

OBJECTIVES

To evaluate the relationship between serial cardiac troponin T (cTnT) levels with infarct size and left ventricular ejection fraction by gated single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) in patients with acute myocardial infarction (AMI).

BACKGROUND

Current guidelines recommend the use of cTnT as the biomarker of choice for the diagnosis of AMI. Data relating cTnT to SPECT-MPI in patients with AMI are limited.

METHODS

A subset of patients with their first AMI participating in a community-based cohort of AMI in Olmsted County, Minnesota, were prospectively studied. Serial cTnT levels were evaluated at presentation, <12 h and 1, 2, and 3 days after onset of pain. Peak cTnT was defined as the maximum cTnT value.

RESULTS

A total of 121 patients (age, 61 ± 13 years; 31% women) with AMI underwent gated SPECT-MPI at a median (25th percentile, 75th percentile) of 10 (5, 15) days post-AMI. The type of infarct was non-ST-segment elevation myocardial infarction in 61%, and 13% were anterior in location. The median infarct size was 1% (0%, 11%) and the median gated left ventricular ejection fraction was 54% (47%, 60%). Fifty-nine patients (49% of the population) had no measurable infarction by SPECT-MPI. Independent predictors of measurable SPECT-MPI infarct size included cTnT at days 1, 2, and 3 and peak cTnT, but not at presentation or <12 h. In receiver-operator characteristic analysis, the area under the curve was highest at day 3. Receiver-operator characteristic analysis demonstrated a cutoff of 1.5 ng/ml for peak cTnT for the detection of measurable infarct size.

CONCLUSIONS

In a community-based cohort of patients with their first AMI, independent predictors of measurable SPECT-MPI infarct size included cTnT at days 1, 2, and 3 and peak cTnT. In contrast, cTnT level at presentation and <12 h was not an independent predictor of myocardial infarction size as assessed by SPECT-MPI. Receiver-operator characteristic analysis demonstrated a cutoff value peak cTnT of 1.5 ng/ml for the detection of measurable infarct.

目的

通过门控单光子发射型计算机断层心肌灌注成像（SPECT-MPI）评估急性心肌梗死（AMI）患者连续心肌肌钙蛋白 T（cTnT）水平与梗死面积和左心室射血分数的关系。

背景

目前的指南建议使用 cTnT 作为 AMI 诊断的首选生物标志物。与 AMI 患者的 SPECT-MPI 相关的数据有限。

方法

前瞻性研究明尼苏达州奥姆斯特德县社区性 AMI 队列中首次发生 AMI 的部分患者。在发病后即刻、<12 小时以及 1、2 和 3 天时评估连续 cTnT 水平。峰值 cTnT 定义为最大 cTnT 值。

结果

共有 121 例 AMI 患者（年龄 61±13 岁；31%为女性）在 AMI 后中位（25%分位数，75%分位数）10（5，15）天时接受了门控 SPECT-MPI。梗死类型为非 ST 段抬高型心肌梗死占 61%，13%为前壁。中位梗死面积为 1%（0%，11%），中位门控左心室射血分数为 54%（47%，60%）。59 例（人群的 49%）患者 SPECT-MPI 未见可测量的梗死。可测量 SPECT-MPI 梗死面积的独立预测因素包括 cTnT 在第 1、2 和 3 天以及峰值 cTnT，但在发病时或<12 小时时无预测作用。在受试者工作特征曲线分析中，曲线下面积在第 3 天最高。受试者工作特征曲线分析显示，峰值 cTnT 的截断值为 1.5ng/ml，用于检测可测量的梗死面积。

结论

在社区性首次 AMI 患者队列中，可测量 SPECT-MPI 梗死面积的独立预测因素包括 cTnT 在第 1、2 和 3 天以及峰值 cTnT。相比之下，cTnT 水平在发病时和<12 小时时并不是 SPECT-MPI 评估的心肌梗死面积的独立预测因素。受试者工作特征曲线分析显示，峰值 cTnT 的截断值为 1.5ng/ml，用于检测可测量的梗死。