Cardiology Department, Virgen de la Arrixaca Hospital and School of Medicine, University of Murcia, Murcia, Spain.
Am Heart J. 2012 Jun;163(6):1002-10. doi: 10.1016/j.ahj.2012.03.015.
A highly sensitive assay for troponin T (hsTnT) has been recently developed, which allows for the detection of even minor myocardial necrosis with high precision. It remains unexplored whether hsTnT provides incremental prognostic accuracy beyond conventional (c)TnT in patients with acutely decompensated heart failure (ADHF).
A total of 202 consecutive patients admitted with ADHF and without criteria for acute myocardial infarction were studied. Troponin T was measured using the highly sensitive assay and compared with the conventional method. Patients were clinically followed up at a median of 406 days, with a primary outcome measure of all-cause mortality.
The high-sensitive assay detected measurable TnT in 98% of patients vs 56% for cTnT; 81% had an hsTnT above the 99th percentile for a healthy reference population, and it reclassified 60% of those with undetectable cTnT. Both TnT methods predicted the risk of death in adjusted multivariable Cox regression analyses, without a superiority of hsTnT over cTnT in the entire population (area under the curve 0.67 vs 0.71, P = .2). Among patients with a cTnT below 0.03 ng/mL (the lowest cut-point with <10% imprecision; n = 134), solely hsTnT improved the prediction of death over clinical risk factors (relative integrated discrimination improvement +36%, P = .01) and hsTnT above 20 pg/mL identified a significant higher risk of death (hazard ratio 4.7, 95% CI 1.6-13.8, P = .005).
Among patients with ADHF, myocardial necrosis (as detected with the hsTnT assay) was nearly ubiquitous. The highly sensitive assay for TnT provides comparable prognostic information to cTnT overall, but among those in whom the cTnT method was less precise or frankly negative, the hsTnT assay provided prognostic information.
最近开发出了一种高敏肌钙蛋白 T（hsTnT）检测方法，该方法可以高精度地检测到即使是轻微的心肌坏死。hsTnT 是否比传统的肌钙蛋白 T（cTnT）在急性失代偿性心力衰竭（ADHF）患者中提供更多的预后准确性，目前仍不清楚。
共纳入 202 例因 ADHF 入院且不符合急性心肌梗死标准的连续患者。使用高敏检测方法测量肌钙蛋白 T，并与传统方法进行比较。中位随访时间为 406 天，主要终点为全因死亡率。
高敏检测方法在 98%的患者中检测到可测量的 TnT，而 cTnT 为 56%；81%的患者 hsTnT 高于健康参考人群的第 99 百分位，它重新分类了 60% cTnT 不可检测的患者。两种 TnT 方法在调整后的多变量 Cox 回归分析中均预测了死亡风险，在整个人群中，hsTnT 并不优于 cTnT（曲线下面积 0.67 对 0.71，P =.2）。在 cTnT 低于 0.03ng/ml（无 10%不精密度的最低截断值；n = 134）的患者中，仅 hsTnT 提高了死亡预测的准确性，超过了临床危险因素（相对综合判别改善率+36%，P =.01），且 hsTnT 高于 20pg/ml 提示死亡风险显著增加（危险比 4.7，95%CI 1.6-13.8，P =.005）。
在 ADHF 患者中，心肌坏死（用 hsTnT 检测方法检测到）几乎无处不在。高敏肌钙蛋白 T 检测方法总体上提供了与 cTnT 相当的预后信息，但在那些 cTnT 方法不那么精确或明显阴性的患者中，hsTnT 检测方法提供了预后信息。
