心肌肌钙蛋白I与心肌肌钙蛋白T在检测运动诱发心肌缺血中的直接比较。
Direct comparison of cardiac troponin I and cardiac troponin T in the detection of exercise-induced myocardial ischemia.
作者信息
Sou Seoung Mann, Puelacher Christian, Twerenbold Raphael, Wagener Max, Honegger Ursina, Reichlin Tobias, Schaerli Nicolas, Pretre Gil, Abächerli Roger, Jaeger Cedric, Rubini Gimenez Maria, Wild Damian, Rentsch Katharina M, Zellweger Michael J, Mueller Christian
机构信息
Department of Cardiology, University Hospital Basel, Switzerland; Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Switzerland.
Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Switzerland.
出版信息
Clin Biochem. 2016 Apr;49(6):421-432. doi: 10.1016/j.clinbiochem.2015.12.005. Epub 2015 Dec 17.
BACKGROUND
It is unknown, whether cardiac troponin (cTn) I or cTnT is the preferred biomarker in the detection of exercise-induced myocardial ischemia.
METHODS
We investigated patients with suspected myocardial ischemia referred for exercise or pharmacological rest/stress myocardial perfusion single-photon emission computed tomography (SPECT) to directly compare the diagnostic accuracy of high-sensitivity cTnI (hs-cTnI) and hs-cTnT. Diagnostic performance was analyzed separately according to stress modality. Hs-cTnI and hs-cTnT were measured before, immediately after, as well as 2h and 4h after maximal exercise in a blinded fashion. Further, all clinical information available to the treating cardiologist was used to quantify the clinical judgment regarding the presence of myocardial ischemia using a visual analog scale twice: once prior and once after stress-testing. The presence of stress-induced myocardial ischemia was adjudicated using SPECT combined with coronary angiography findings.
RESULT
A total of 403 consecutive patients were enrolled in our study, of which 229 underwent exercise stress and 174 patients pharmacological stress. Exercise-stress-induced myocardial ischemia was detected in 90 patients (39.3% of 229). Levels of hs-cTnI and hs-cTnT were both significantly higher at all time-points examined in patients with exercise-induced myocardial ischemia as compared to patients without myocardial ischemia (all p<0.001). Correlation of hs-cTnI and hs-cTnT was high in direct comparison of time-points (Spearman's rho all ≥0.7). The AUCs for baseline/peak/2h/4h for hs-cTnI and hs-cTnT were 0.71/0.71/0.72/0.69 vs. 0.74/0.73/0.71/0.72, respectively (all p=ns for hs-cTnI versus hs-cTnT). In patients undergoing pharmacological stress, the AUCs for baseline/peak/2h/4h for hs-cTnI and hs-cTnT were 0.66/0.66/0.68/0.67 and 0.61/0.62/0.64/0.59, respectively (all p=ns for hs-cTnI versus hs-cTnT). Also the combinations including clinical judgment or changes during serial sampling were similar for hs-cTnI and hs-cTnT (all p=ns).
CONCLUSIONS
Hs-cTnI and hs-cTnT provide comparable diagnostic information regarding exercise-induced myocardial ischemia. Overall, their diagnostic accuracy seems moderate.
UNIQUE IDENTIFIER
NCT01838148.
背景
尚不清楚心肌肌钙蛋白（cTn）I 还是 cTnT 是检测运动诱发心肌缺血的首选生物标志物。
方法
我们对疑似心肌缺血并接受运动或药物负荷/静息心肌灌注单光子发射计算机断层扫描（SPECT）的患者进行了研究，以直接比较高敏 cTnI（hs-cTnI）和 hs-cTnT 的诊断准确性。根据负荷方式分别分析诊断性能。以盲法在最大运动前、运动后即刻、运动后 2 小时和 4 小时测量 hs-cTnI 和 hs-cTnT。此外，利用治疗心脏病专家可获得的所有临床信息，使用视觉模拟量表两次量化关于心肌缺血存在的临床判断：一次在负荷试验前，一次在负荷试验后。通过 SPECT 结合冠状动脉造影结果判定负荷诱发的心肌缺血的存在。
结果
我们的研究共纳入 403 例连续患者，其中 229 例接受运动负荷，174 例接受药物负荷。在 90 例患者（229 例中的 39.3%）中检测到运动负荷诱发的心肌缺血。与无心肌缺血的患者相比，运动诱发心肌缺血的患者在所有检测时间点的 hs-cTnI 和 hs-cTnT 水平均显著更高（所有 p<0.001）。在时间点的直接比较中，hs-cTnI 和 hs-cTnT 的相关性很高（Spearman 相关系数均≥0.7）。hs-cTnI 和 hs-cTnT 的基线/峰值/2 小时/4 小时的曲线下面积（AUC）分别为 0.71/0.71/0.72/0.69 和 0.
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