急性心力衰竭中的肌钙蛋白T：西班牙国家心力衰竭注册研究中的临床意义及预后

Troponin T in acute heart failure: clinical implications and prognosis in the Spanish National Registry on Heart Failure.

作者信息

Guisado Espartero María Esther, Salamanca-Bautista Prado, Aramburu-Bodas Oscar, Arias-Jimenez Jose L, Formiga Francesc, Roca-Villanueva Bernardino, Cerqueiro-Gonzalez Jose M, Davila-Ramos Meliton F, Sanchez-Marteles Marta, Montero-Perez-Barquero Manuel

机构信息

Department of Internal Medicine, Hospital Infanta Margarita, Avenida Góngora s/n, CP: 14940 Cabra, Córdoba, Spain.

出版信息

Eur J Intern Med. 2014 Oct;25(8):739-44. doi: 10.1016/j.ejim.2014.08.005. Epub 2014 Sep 6.

DOI:10.1016/j.ejim.2014.08.005

PMID:25200802

Abstract

BACKGROUND

Elevated troponin in heart failure has been associated with worse prognosis, but there are differences in the design and results of published studies. Our objective was to determine the association of troponin T with mortality and readmissions in patients with acute heart failure in clinical practice conditions.

METHODS

We included patients from the RICA registry who were hospitalized for acute heart failure. They were classified into 3 groups according to troponin T levels: normal, intermediate and high (<0.02, 0.02-0.049 and ≥ 0.05 ng/mL, respectively). Survival was studied by Kaplan-Meier curves and the association of variables was tested by Cox regression analysis.

RESULTS

A total of 406 patients was included. Average age was 76.9 (76.0-77.7) years. Hypertensive heart disease was the most common etiology. Left ventricular ejection fraction was <45% in 22.1% of the patients. The group with elevated troponin T had higher proportions of women, systolic dysfunction, renal failure and anemia, a lower body mass index and longer hospital stay. At one year, patients with elevated troponin T had higher mortality than patients with normal troponin (35.5 vs. 13.9%, p<0.001). The composite event (mortality and readmissions) was also more frequent (51.6 vs. 30.9%, p<0.001), but there were no differences in readmissions alone. Troponin T ≥ 0.02 ng/mL was independently associated with mortality.

CONCLUSIONS

Elevated troponin T levels are common in patients with heart failure in clinical practice and are associated with increased mortality and events after one year of follow-up.

摘要

背景

心力衰竭患者肌钙蛋白升高与预后较差相关，但已发表研究的设计和结果存在差异。我们的目的是确定在临床实践条件下，肌钙蛋白T与急性心力衰竭患者的死亡率和再入院率之间的关联。

方法

我们纳入了因急性心力衰竭住院的RICA登记处患者。根据肌钙蛋白T水平将他们分为3组：正常、中等和高（分别为<0.02、0.02 - 0.049和≥0.05 ng/mL）。通过Kaplan-Meier曲线研究生存率，并通过Cox回归分析检验变量之间的关联。

结果

共纳入406例患者。平均年龄为76.9（76.0 - 77.7）岁。高血压性心脏病是最常见的病因。22.1%的患者左心室射血分数<45%。肌钙蛋白T升高组女性、收缩功能障碍、肾衰竭和贫血的比例更高，体重指数更低，住院时间更长。1年时，肌钙蛋白T升高的患者死亡率高于肌钙蛋白正常的患者（35.5%对13.9%，p<0.001）。复合事件（死亡率和再入院率）也更频繁（51.6%对30.9%，p<0.001），但单独再入院率没有差异。肌钙蛋白T≥0.02 ng/mL与死亡率独立相关。