Eindhoven Jannet A, Roos-Hesselink Jolien W, van den Bosch Annemien E, Kardys Isabella, Cheng Jin M, Veenis Jesse F, Cuypers Judith A A E, Witsenburg Maarten, van Schaik Ron H N, Boersma Eric
Department of cardiology, Thorax Center, Erasmus MC, Rotterdam, The Netherlands.
Department of cardiology, Thorax Center, Erasmus MC, Rotterdam, The Netherlands.
Int J Cardiol. 2015 Apr 1;184:405-411. doi: 10.1016/j.ijcard.2015.02.027. Epub 2015 Feb 25.
Adult congenital heart disease (ACHD) patients are at risk of late complications including arrhythmias, heart failure and sudden death. High-sensitive troponin-T (hs-TnT) is the standard for diagnosing acute coronary syndrome, but is also associated with cardiac function and prognosis in other cardiac diseases. We aimed to describe hs-TnT level in ACHD patients, and determine its relationship with cardiac function and other biomarkers.
Consecutive ACHD patients, visiting the outpatient clinic, underwent echocardiography, exercise testing and venipuncture on the same day.
In total 587 patients were included (median age 33 [IQR 25-41] years, 58% male, 90% NYHA class I). hs-TnT was above the detection limit of 5 ng/L in 241 patients (41%), of whom 47 (8%) had hs-TnT levels above the 99th percentile of normal of 14 ng/L. hs-TnT levels were highest in patients with a systemic RV or pulmonary hypertension. Patients with normal or non-detectable hs-TnT were younger (32 [IQR 24-40] years) than patient with elevated hs-TnT (42 [IQR 36-60] years, p<0.001). The prevalence of hs-TnT ≥14 ng/L was higher in patients with NYHA ≥II (36%, p<0.001), systemic systolic dysfunction (38%, p<0.001), non-sinus rhythm (43%, p<0.001) and elevated pulmonary pressures (39%, p<0.001). hs-TnT was correlated with NT-proBNP (r=0.400, p<0.001).
hs-TnT above the 99th percentile of normal is observed in a non-trivial portion of stable ACHD patients, especially in those with a systemic RV or elevated pulmonary pressures. Since this biomarker of myocardial damage is related to NT-proBNP and ventricular function, its potential predictive value in ACHD patients seems promising and further investigation of underlying mechanisms is warranted.
成人先天性心脏病（ACHD）患者存在发生晚期并发症的风险，包括心律失常、心力衰竭和猝死。高敏肌钙蛋白T（hs-TnT）是诊断急性冠状动脉综合征的标准，但也与其他心脏病的心脏功能和预后相关。我们旨在描述ACHD患者的hs-TnT水平，并确定其与心脏功能和其他生物标志物的关系。
连续就诊于门诊的ACHD患者在同一天接受超声心动图检查、运动试验和静脉穿刺。
共纳入587例患者（中位年龄33岁[四分位间距25 - 41岁]，58%为男性，90%为纽约心脏协会（NYHA）I级）。241例患者（41%）的hs-TnT高于检测下限5 ng/L，其中47例（8%）的hs-TnT水平高于正常上限14 ng/L的第99百分位数。hs-TnT水平在具有体循环右心室或肺动脉高压的患者中最高。hs-TnT正常或未检测到的患者比hs-TnT升高的患者更年轻（32岁[四分位间距24 - 40岁] vs 42岁[四分位间距36 - 60岁]，p<0.001）。NYHA≥II级（36%，p<0.001）、体循环收缩功能障碍（38%，p<0.001）、非窦性心律（43%，p<0.001）和肺动脉压升高（39%，p<0.001）的患者中hs-TnT≥14 ng/L的患病率更高。hs-TnT与N末端B型利钠肽原（NT-proBNP）相关（r = 0.400，p<0.001）。
在相当一部分稳定的ACHD患者中观察到hs-TnT高于正常上限的第99百分位数，尤其是在具有体循环右心室或肺动脉压升高的患者中。由于这种心肌损伤生物标志物与NT-proBNP和心室功能相关，其在ACHD患者中的潜在预测价值似乎很有前景，有必要进一步研究其潜在机制。
