持续性心房颤动中肌钙蛋白I水平——心率控制和运动试验的影响
Troponin I levels in permanent atrial fibrillation-impact of rate control and exercise testing.
作者信息
Horjen Anja Wiedswang, Ulimoen Sara Reinvik, Enger Steve, Norseth Jon, Seljeflot Ingebjørg, Arnesen Harald, Tveit Arnljot
机构信息
Department of Medical Research, Baerum Hospital, Vestre Viken Hospital Trust, N-3004, Drammen, Norway.
Faculty of Medicine, University of Oslo, Oslo, Norway.
出版信息
BMC Cardiovasc Disord. 2016 May 4;16:79. doi: 10.1186/s12872-016-0255-x.
BACKGROUND
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.
METHODS
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.
RESULTS
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).
CONCLUSIONS
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.
TRIAL REGISTRATION
www.clinicaltrials.gov ( NCT00313157 ).
背景
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。
方法
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。
结果
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。
结论
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。
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