Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
J Am Coll Cardiol. 2013 May 7;61(18):1906-13. doi: 10.1016/j.jacc.2012.12.048. Epub 2013 Mar 6.
This study sought to assess changes in troponin levels, underlying conditions, and the prognostic implications in elderly subjects from the community.
Cardiac troponin levels are often detectable in community dwellers when sensitive assays are applied. However, information on the course of troponin levels over time is limited.
Cardiac troponin I (cTnI) was measured by using a novel, high-sensitive assay in community dwellers aged 70 years from the Prospective Investigation of the Vasculature in Uppsala Seniors study. Measurements were performed at baseline (n = 1,004) and after 5 years (n = 814). Total follow-up was 8.0 years.
cTnI levels were detectable in 968 (96.4%) subjects at baseline and independently predicted all-cause mortality (adjusted hazard ratio [HR]: 1.44 [95% confidence interval (CI): 1.18 to 1.77]) and cardiovascular mortality (adjusted HR: 1.66 [95% CI: 1.20 to 2.29]) when levels from baseline and 5-year follow-up were used as updated covariates. The integrated discrimination improvement of cTnI regarding all-cause mortality was 0.014 (p = 0.04), and the category-free net reclassification improvement was 0.231 (p = 0.02). Median cTnI levels increased by 45% between both measurements. The change in cTnI levels was significantly related to male sex (p = 0.02), body mass index (p = 0.01), high-density lipoprotein cholesterol (p = 0.005), N-terminal pro-B-type natriuretic peptide (p = 0.004), and left ventricular ejection fraction (p = 0.04), and it independently predicted all-cause mortality occurring after 5-year follow-up (adjusted HR: 1.97 [95% CI: 1.14 to 3.40]; p = 0.02).
Using a novel high-sensitive assay, cTnI levels could be determined in nearly all elderly study subjects. cTnI levels increased over time and were a strong marker of mortality risk. Our data suggest that cTnI might offer utility for clinical assessment of subjects in the general population.
本研究旨在评估社区老年人中肌钙蛋白水平的变化、潜在疾病及预后意义。
当应用高灵敏度检测方法时，心肌肌钙蛋白水平在社区居民中常常是可检测到的。然而，关于肌钙蛋白水平随时间推移的变化情况的信息是有限的。
在 Prospective Investigation of the Vasculature in Uppsala Seniors 研究中，对年龄在 70 岁的社区居民应用新型高敏检测方法测量心肌肌钙蛋白 I（cTnI）。在基线（n=1004）和 5 年后（n=814）进行了测量。总随访时间为 8.0 年。
在基线时，968（96.4%）名受试者可检测到 cTnI 水平，并且当将基线和 5 年随访时的水平用作更新的协变量时，cTnI 水平独立预测全因死亡率（校正后的危险比[HR]：1.44[95%置信区间（CI）：1.18 至 1.77]）和心血管死亡率（校正后的 HR：1.66[95%CI：1.20 至 2.29]）。cTnI 对全因死亡率的综合判别改善为 0.014（p=0.04），无分类净重新分类改善为 0.231（p=0.02）。两次测量之间，cTnI 水平中位数增加了 45%。cTnI 水平的变化与男性（p=0.02）、体重指数（p=0.01）、高密度脂蛋白胆固醇（p=0.005）、氨基末端 pro-B 型利钠肽（p=0.004）和左心室射血分数（p=0.04）显著相关，且独立预测 5 年后随访时发生的全因死亡率（校正后的 HR：1.97[95%CI：1.14 至 3.40]；p=0.02）。
应用新型高敏检测方法，几乎可以在所有老年研究对象中确定 cTnI 水平。cTnI 水平随时间推移而增加，是死亡率风险的有力标志物。我们的数据表明，cTnI 可能对一般人群中患者的临床评估有一定作用。
