Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
Am J Cardiol. 2012 Oct 15;110(8):1180-4. doi: 10.1016/j.amjcard.2012.05.061. Epub 2012 Jul 6.
Increased troponin is associated with poor survival in patients with amyloid light-chain (AL) amyloidosis with cardiac involvement (CAL). The purpose of this investigation was to define the relation between increased troponin and clinical, morphologic, and functional features. The comparative utility of clinical, echocardiographic, and biochemical measurements in predicting survival in CAL was also investigated. One hundred seventeen patients with CAL were divided into 2 groups: normal troponin I (<0.06 ng/ml, n = 42) or increased troponin I (≥0.06 ng/ml, n = 75). Patients in the high troponin I group were older (63 vs 58 years, p = 0.04), with higher B-type natriuretic peptide levels (1,417 vs 936 pg/ml, p = 0.0004). The high troponin I group also had higher echocardiography-determined early/late mitral inflow velocity ratio (2.2 vs 1.4, p = 0.005) and myocardial performance index (0.59 vs 0.45, p = 0.04) and lower stroke index (28 vs 38 ml/beat/m(2), p <0.0001) and left atrial systolic force (5.9 vs 8.4 k-dynes, p = 0.037) than the normal troponin group. Median survival was significantly shorter in the high troponin group (11 vs 45 months, p <0.001). At time of CAL diagnosis, univariate predictors of all-cause mortality included increased troponin, older age, male gender, New York Heart Association class III to IV, >2 organs involved, higher B-type natriuretic peptide, lower creatinine clearance, greater ventricular septal thickness, and higher myocardial performance index. However, by multivariate Cox survival analysis, only increased troponin was a significant predictor for all-cause mortality (hazard ratio 3.1, p = 0.002). In conclusion, increased troponin is associated with worse left ventricular and left atrial functions by echocardiography in patients with CAL. Among baseline variables, it is the strongest predictor of all-cause mortality in multivariate analysis. Troponin is a powerful tool in clinical and prognostic assessments of patients with CAL.
在合并心脏受累的轻链淀粉样变性（AL）患者（CAL）中，肌钙蛋白升高与较差的生存率相关。本研究旨在确定肌钙蛋白升高与临床、形态学和功能特征之间的关系。还研究了临床、超声心动图和生化测量在预测 CAL 患者生存中的比较效用。117 例 CAL 患者分为两组：正常肌钙蛋白 I（<0.06ng/ml，n=42）或升高肌钙蛋白 I（≥0.06ng/ml，n=75）。高肌钙蛋白 I 组患者年龄更大（63 岁比 58 岁，p=0.04），B 型利钠肽水平更高（1417pg/ml 比 936pg/ml，p=0.0004）。高肌钙蛋白 I 组的早期/晚期二尖瓣流入速度比（2.2 比 1.4，p=0.005）和心肌性能指数（0.59 比 0.45，p=0.04）也更高，而射血分数（28ml/beat/m2 比 38ml/beat/m2，p<0.0001）和左心房收缩力（5.9k-dynes 比 8.4k-dynes，p=0.037）则更低。高肌钙蛋白组的中位生存期明显短于正常肌钙蛋白组（11 个月比 45 个月，p<0.001）。在 CAL 诊断时，全因死亡率的单因素预测因素包括肌钙蛋白升高、年龄较大、男性、纽约心脏协会心功能分级 III 至 IV 级、>2 个器官受累、B 型利钠肽水平较高、肌酐清除率较低、室间隔厚度较大和心肌性能指数较高。然而，通过多变量 Cox 生存分析，只有肌钙蛋白升高是全因死亡率的显著预测因子（风险比 3.1，p=0.002）。总之，在 CAL 患者中，肌钙蛋白升高与超声心动图显示的左心室和左心房功能较差相关。在基线变量中，它是多变量分析中全因死亡率的最强预测因子。肌钙蛋白是评估 CAL 患者临床和预后的有力工具。
