Cardiology Division, University of Maryland, Baltimore, Maryland.
J Am Coll Cardiol. 2013 Dec 3;62(22):2112-20. doi: 10.1016/j.jacc.2013.07.049. Epub 2013 Aug 21.
This study sought to determine the association between markers of cardiomyocyte injury in ambulatory subjects and sudden cardiac death (SCD).
The pathophysiology of SCD is complex but is believed to be associated with an abnormal cardiac substrate in most cases. The association between biomarkers of cardiomyocyte injury in ambulatory subjects and SCD has not been investigated.
Levels of cardiac troponin T, a biomarker of cardiomyocyte injury, were measured by a highly sensitive assay (hsTnT) in 4,431 ambulatory participants in the Cardiovascular Health Study, a longitudinal community-based prospective cohort study. Serial measures were obtained in 3,089 subjects. All deaths, including SCD, were adjudicated by a central events committee.
Over a median follow-up of 13.1 years, 246 participants had SCD. Baseline levels of hsTnT were significantly associated with SCD (hazard ratio [HR] for +1 log(hsTnT): 2.04, 95% confidence interval [CI]: 1.78 to 2.34]. This association persisted in covariate-adjusted Cox analyses accounting for baseline risk factors (HR: 1.30, 95% CI: 1.05 to 1.62), as well as for incident heart failure and myocardial infarction (HR: 1.26, 95% CI: 1.01 to 1.57). The population was also categorized into 3 groups based on baseline hsTnT levels and SCD risk [fully adjusted HR: 1.89 vs. 1.55 vs. 1 (reference group) for hsTnT ≥12.10 vs. 5.01 to 12.09 vs. ≤ 5.00 pg/ml, respectively; p trend = 0.005]. On serial measurements, change in hsTnT levels was also associated with SCD risk (fully adjusted HR for +1 pg/ml per year increase from baseline: 1.03, 95% CI: 1.01 to 1.06).
The findings suggest an association between cardiomyocyte injury in ambulatory subjects and SCD risk beyond that of traditional risk factors.
本研究旨在确定动态监测的心肌细胞损伤标志物与心脏性猝死（SCD）之间的关联。
SCD 的病理生理学较为复杂，但大多数情况下被认为与异常的心脏基质有关。动态监测的心肌细胞损伤标志物与 SCD 之间的关联尚未得到研究。
在心血管健康研究（一项基于社区的前瞻性队列研究）中，使用高敏检测（hsTnT）对 4431 名动态监测的参与者进行了心肌细胞损伤标志物——心脏肌钙蛋白 T 的水平检测。对 3089 名受试者进行了连续测量。所有死亡事件（包括 SCD）均由中央事件委员会进行裁决。
中位随访 13.1 年后，有 246 名参与者发生了 SCD。hsTnT 的基线水平与 SCD 显著相关（每增加 1 个对数单位的 hsTnT 的风险比[HR]：2.04，95%置信区间[CI]：1.78 至 2.34）。这种关联在调整了基线风险因素的协方差 Cox 分析中仍然存在（HR：1.30，95% CI：1.05 至 1.62），也存在于新发心力衰竭和心肌梗死的调整分析中（HR：1.26，95% CI：1.01 至 1.57）。根据基线 hsTnT 水平和 SCD 风险，人群还分为 3 组[完全调整后的 HR：1.89 比 1.55 比 1（参考组），对于 hsTnT≥12.10 比 5.01 至 12.09 比≤5.00 pg/ml，分别；趋势 p 值=0.005]。在连续测量中，hsTnT 水平的变化也与 SCD 风险相关（从基线每年增加 1 pg/ml 的完全调整后 HR：1.03，95% CI：1.01 至 1.06）。
这些发现表明，与传统危险因素相比，动态监测的心肌细胞损伤与 SCD 风险之间存在关联。
