Centre for Cardiovascular and Lung Biology, University of Dundee, United Kingdom.
J Am Coll Cardiol. 2012 Sep 11;60(11):960-8. doi: 10.1016/j.jacc.2012.04.049. Epub 2012 Aug 22.
The aim of this study was to examine whether biomarkers can identify silent cardiac target organ damage (cTOD) in a primary prevention population.
One possible way to improve primary prevention of cardiovascular events is to identify those patients who already harbor silent cTOD (i.e., myocardial ischemia, left ventricular hypertrophy, systolic dysfunction, diastolic dysfunction, or left atrial enlargement). This might be possible by screening with a biomarker (e.g. high sensitivity cardiac troponin T [hs-cTnT] or B-type natriuretic peptide [BNP]).
We prospectively recruited 300 asymptomatic individuals already receiving primary prevention therapy. Transthoracic echocardiography, stress echocardiography, and/or myocardial perfusion imaging were performed to identify silent cTOD.
One hundred two (34%) patients had evidence of cTOD. Left ventricular hypertrophy was the most prevalent (29.7%) form of cTOD, followed by diastolic dysfunction (21.3%), left atrial enlargement (15.3%), systolic dysfunction (6.3%), and ischemia (6.3%). The area under the curve (AUC) for BNP to identify any form of silent cTOD was 0.78 overall and 0.82 in men. The equivalent figures for hs-cTnT were 0.70 and 0.75 in women. The AUC for BNP and hs-cTnT together was 0.81 and 0.82 in men. However, the discrimination power of other markers was poor, with AUCs of 0.61 for microalbuminuria, 0.49 for uric acid, and 0.58 for eGFR.
In asymptomatic treated primary prevention patients, BNP screening is able to identify existing silent cTOD. The performance of hs-cTnT was not as good as that of BNP. B-type natriuretic peptide plus hs-cTnT together performed best. Prescreening with BNP ± cTnT followed by targeted phenotyping is worth exploring further as a possible way to improve primary prevention.
本研究旨在探讨生物标志物是否可用于识别初级预防人群中的无症状心脏靶器官损伤（cTOD）。
改善心血管事件初级预防的一种可能方法是识别那些已经存在无症状 cTOD（即心肌缺血、左心室肥厚、收缩功能障碍、舒张功能障碍或左心房扩大）的患者。这可能通过筛查生物标志物（如高敏心肌肌钙蛋白 T [hs-cTnT]或 B 型利钠肽 [BNP]）来实现。
我们前瞻性招募了 300 名已接受初级预防治疗的无症状个体。进行经胸超声心动图、负荷超声心动图和/或心肌灌注成像以识别无症状 cTOD。
102 名（34%）患者存在 cTOD 证据。左心室肥厚是最常见的 cTOD 形式（29.7%），其次是舒张功能障碍（21.3%）、左心房扩大（15.3%）、收缩功能障碍（6.3%）和缺血（6.3%）。BNP 识别任何形式无症状 cTOD 的曲线下面积（AUC）总体为 0.78，男性为 0.82。hs-cTnT 的相应数值为女性 0.70 和 0.75。BNP 和 hs-cTnT 联合的 AUC 在男性中为 0.81 和 0.82。然而，其他标志物的判别能力较差，微量白蛋白尿的 AUC 为 0.61，尿酸的 AUC 为 0.49，eGFR 的 AUC 为 0.58。
在无症状接受初级预防治疗的患者中，BNP 筛查可识别现有的无症状 cTOD。hs-cTnT 的性能不如 BNP。BNP+hs-cTnT 联合检测的效果最佳。BNP±hs-cTnT 进行预筛查，然后进行靶向表型分析，可能是提高初级预防效果的一种方法，值得进一步探索。
