Horjen Anja Wiedswang, Ulimoen Sara Reinvik, Enger Steve, Norseth Jon, Seljeflot Ingebjørg, Arnesen Harald, Tveit Arnljot
Department of Medical Research, Baerum Hospital, Vestre Viken Hospital Trust, N-3004, Drammen, Norway.
Faculty of Medicine, University of Oslo, Oslo, Norway.
BMC Cardiovasc Disord. 2016 May 4;16:79. doi: 10.1186/s12872-016-0255-x.
High-sensitivity troponin I (hs-TnI) and troponin T (hs-TnT) are moderately correlated and independently related to outcome in atrial fibrillation (AF). Rate controlling therapy has been shown to reduce hs-TnT, however the potential impact on hs-TnI levels, and whether this differs from the effects on hs-TnT, has not been investigated previously.
Sixty patients with stable, permanent AF without heart failure or known ischemic heart disease were included in a randomised crossover study (mean age 71 ± 9 years, 18 women). Diltiazem 360 mg, verapamil 240 mg, metoprolol 100 mg, and carvedilol 25 mg were administered once daily for three weeks, in a randomised sequence. At baseline and on the last day of each treatment period, hs-TnI was measured at rest and after a maximal exercise test and compared to hs-TnT.
Hs-TnI and hs-TnT correlated moderately at baseline (rs = 0.582, p < 0.001). All drugs reduced both the resting and the peak exercise levels of hs-TnI compared with baseline (p < 0.001 for all). The decline in resting hs-TnI and hs-TnT values relative to baseline levels was similar for all drugs except for verapamil, which reduced hs-TnI more than hs-TnT (p = 0.017). Levels of hs-TnI increased significantly in response to exercise testing at baseline and at all treatment regimens (p < 0.001 for all). The relative exercise-induced increase in hs-TnI was significantly larger compared to hs-TnT at baseline (p < 0.001), on diltiazem (p < 0.001) and on verapamil (p = 0.001).
In our population of stable, permanent AF patients, all four rate control drug regimens reduced hs-TnI significantly, both at rest and during exercise. The decline in hs-TnI and hs-TnT levels associated with beta-blocker and calcium channel blocker treatment was similar, except for a larger relative decrease in hs-TnI levels following verapamil treatment.
www.clinicaltrials.gov ( NCT00313157 ).
高敏肌钙蛋白I（hs-TnI）和肌钙蛋白T（hs-TnT）中度相关，且与心房颤动（AF）的预后独立相关。心率控制治疗已被证明可降低hs-TnT水平，然而其对hs-TnI水平的潜在影响，以及这种影响是否与对hs-TnT的影响不同，此前尚未进行研究。
60例无心力衰竭或已知缺血性心脏病的稳定永久性AF患者纳入一项随机交叉研究（平均年龄71±9岁，18例女性）。地尔硫䓬360mg、维拉帕米240mg、美托洛尔100mg和卡维地洛25mg以随机顺序每日服用一次，共三周。在基线和每个治疗期的最后一天，于静息状态和最大运动试验后测量hs-TnI，并与hs-TnT进行比较。
基线时hs-TnI和hs-TnT中度相关（rs = 0.582，p < 0.001）。与基线相比，所有药物均降低了hs-TnI的静息和运动峰值水平（所有p < 0.001）。除维拉帕米外，所有药物使静息hs-TnI和hs-TnT值相对于基线水平的下降相似，维拉帕米降低hs-TnI的幅度大于hs-TnT（p = 0.017）。在基线和所有治疗方案下，运动试验后hs-TnI水平均显著升高（所有p < 0.001）。在基线时（p < 0.001）、服用地尔硫䓬时（p < 0.001）和服用维拉帕米时（p = 0.001），运动诱导的hs-TnI相对升高幅度显著大于hs-TnT。
在我们的稳定永久性AF患者群体中，所有四种心率控制药物方案均显著降低了静息和运动时的hs-TnI水平。β受体阻滞剂和钙通道阻滞剂治疗导致的hs-TnI和hs-TnT水平下降相似，除维拉帕米治疗后hs-TnI水平相对下降幅度更大。
