Lai Clare T M, Wong Sophia J, Ip Janice J K, Wong Wai-keung, Tsang Kwong-cheong, Lam Wendy W M, Cheung Yiu-fai
Division of Paediatric Cardiology, Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.
Department of Radiology, Queen Mary Hospital, Hong Kong, China.
Sci Rep. 2015 Sep 11;5:14050. doi: 10.1038/srep14050.
Detectable low circulating level of cardiac troponin T (cTnT) may reflect subclinical myocardial injury. We tested the hypothesis that circulating levels of hs-cTnT are altered in adults with repaired tetralogy of Fallot (TOF) and associated with ventricular volume load and function. Eighty-eight TOF patients and 48 controls were studied. Plasma hs-cTnT levels were determined using a highly sensitive assay (hs-cTnT). The right (RV) and left ventricular (LV) volumes and ejection fraction (EF) were measured using 3D echocardiography and, in 52 patients, cardiac magnetic resonance (CMR). The median (interquartile range) for male and female patients were 4.87 (3.83-6.62) ng/L and 3.11 (1.00-3.87) ng/L, respectively. Thirty percent of female but none of the male patients had increased hs-cTnT levels. Female patients with elevated hs-cTnT levels, compared to those without, had greater RV end-diastolic and end-systolic volumes and LV systolic dyssynchrony index (all p < 0.05). For patient cohort only, hs-cTnT levels correlated positively with CMR-derived RV end-diastolic volume and negatively with echocardiography-derived LV and RV EF (all p < 0.05). Multiple linear regression identified sex and RV EF as significant correlates of log-transformed hs-cTnT levels. Increased hs-cTnT levels occur in 30% of female patients after TOF repair, and are associated with greater RV volumes and worse RV EF.
可检测到的低循环水平心肌肌钙蛋白T（cTnT）可能反映亚临床心肌损伤。我们检验了以下假设：在法洛四联症（TOF）修复术后的成年人中，高敏心肌肌钙蛋白T（hs-cTnT）的循环水平会发生改变，且与心室容量负荷和功能相关。研究了88例TOF患者和48例对照。使用高敏检测法（hs-cTnT）测定血浆hs-cTnT水平。使用三维超声心动图测量右心室（RV）和左心室（LV）容量及射血分数（EF），52例患者还进行了心脏磁共振成像（CMR）检查。男性和女性患者的中位数（四分位间距）分别为4.87（3.83 - 6.62）ng/L和3.11（1.00 - 3.87）ng/L。30%的女性患者hs-cTnT水平升高，而男性患者无一例升高。与hs-cTnT水平未升高的女性患者相比，hs-cTnT水平升高的女性患者右心室舒张末期和收缩末期容积更大，左心室收缩不同步指数更高（均p < 0.05）。仅对于患者队列，hs-cTnT水平与CMR测定的右心室舒张末期容积呈正相关，与超声心动图测定的左心室和右心室EF呈负相关（均p < 0.05）。多元线性回归分析确定性别和右心室EF是对数转换后hs-cTnT水平的显著相关因素。TOF修复术后30%的女性患者hs-cTnT水平升高，且与更大的右心室容积和更差的右心室EF相关。
