在非缺血性心力衰竭患者中，冠状动脉微血管功能障碍和舒张负荷与高敏检测的心肌肌钙蛋白 T 释放相关。
Coronary microvascular dysfunction and diastolic load correlate with cardiac troponin T release measured by a highly sensitive assay in patients with nonischemic heart failure.
机构信息
Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
出版信息
J Am Coll Cardiol. 2013 Aug 13;62(7):632-40. doi: 10.1016/j.jacc.2013.03.065. Epub 2013 May 1.
OBJECTIVES
This study investigated factors associated with cardiac troponin T (cTnT) release from failing myocardium.
BACKGROUND
Persistent and modest elevation of serum cTnT is frequently observed in heart failure (HF) patients free of coronary artery disease, although the mechanisms underlying this finding remain unclear.
METHODS
We evaluated serum cTnT levels in the aortic root (Ao) and coronary sinus (CS) using a highly sensitive assay in 90 nonischemic HF patients and 47 non-HF patients. Transcardiac cTnT and plasma B-type natriuretic peptide (BNP) release were described as the differences between CS and Ao cTnT levels [ΔcTnT (CS-Ao)] and BNP levels [ΔBNP (CS-Ao)], respectively. Coronary flow reserve (CFR) was measured in 68 HF patients using an intracoronary Doppler guidewire.
RESULTS
ΔcTnT (CS-Ao) levels were available in 76 HF patients and 28 non-HF patients (84% vs. 60%; p = 0.001), and higher in HF patients than non-HF patients (p < 0.001). Among HF patients, log[ΔcTnT (CS-Ao)] correlated with log[ΔBNP (CS-Ao)] (r = 0.368, p = 0.001), pulmonary capillary wedge pressure (r = 0.253, p = 0.03) and left ventricular end-diastolic pressure (LVEDP) (r = 0.321, p = 0.005). Multivariate regression analysis identified LVEDP as an independent parameter that correlated with ΔcTnT (CS-Ao). ΔcTnT (CS-Ao) levels were available in 58 HF patients who were evaluated for CFR. Coronary microvascular dysfunction, diagnosed by CFR <2.0, was observed in 18 HF patients. ΔcTnT (CS-Ao) was higher in patients with coronary microvascular dysfunction (4.8 [2.0 to 8.1] ng/l) than those without (2.0 [1.2 to 4.6] ng/l; p = 0.04).
CONCLUSIONS
cTnT release from failing myocardium correlated with diastolic load and coronary microvascular dysfunction in nonischemic HF patients.
目的
本研究旨在探讨与衰竭心肌中心肌钙蛋白 T（cTnT）释放相关的因素。
背景
尽管这种现象的机制尚不清楚，但在无冠状动脉疾病的心力衰竭（HF）患者中，常观察到血清 cTnT 持续且适度升高。
方法
我们使用高敏检测方法评估了 90 例非缺血性 HF 患者和 47 例非 HF 患者的主动脉根部（Ao）和冠状窦（CS）中的血清 cTnT 水平。通过 CS 与 Ao 之间的 cTnT 水平差值[ΔcTnT（CS-Ao）]和 B 型利钠肽（BNP）水平差值[ΔBNP（CS-Ao）]来描述跨心肌 cTnT 和血浆 BNP 的释放。在 68 例 HF 患者中使用冠状动脉内多普勒导丝测量冠状动脉血流储备（CFR）。
结果
76 例 HF 患者和 28 例非 HF 患者可获得 ΔcTnT（CS-Ao）水平（84%比 60%；p=0.001），HF 患者的水平高于非 HF 患者（p<0.001）。在 HF 患者中，log[ΔcTnT（CS-Ao）]与 log[ΔBNP（CS-Ao）]呈正相关（r=0.368，p=0.001），与肺毛细血管楔压（r=0.253，p=0.03）和左心室舒张末期压（LVEDP）（r=0.321，p=0.005）呈正相关。多变量回归分析发现 LVEDP 是与 ΔcTnT（CS-Ao）相关的独立参数。58 例 HF 患者可评估 CFR，其可获得 ΔcTnT（CS-Ao）水平。通过 CFR<2.0 诊断为冠状动脉微血管功能障碍的患者有 18 例。冠状动脉微血管功能障碍患者的 ΔcTnT（CS-Ao）水平更高（4.8[2.0 至 8.1]ng/l），而非冠状动脉微血管功能障碍患者的水平更低（2.0[1.2 至 4.6]ng/l；p=0.04）。
结论
非缺血性 HF 患者中，衰竭心肌中心肌钙蛋白 T 的释放与舒张负荷和冠状动脉微血管功能障碍相关。
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