急性肺栓塞中的高敏肌钙蛋白与右心室功能
High-sensitivity troponin and right ventricular function in acute pulmonary embolism.
作者信息
Daquarti Gustavo, March Vecchio Nicolás, Mitrione Cecilia Soledad, Furmento Juan, Ametrano María Clara, Dominguez Pace María Paz, Costabel Juan Pablo
机构信息
Instituto Cardiovascular de Buenos Aires (ICBA), Buenos Aires, Argentina.
Instituto Cardiovascular de Buenos Aires (ICBA), Buenos Aires, Argentina.
出版信息
Am J Emerg Med. 2016 Aug;34(8):1579-82. doi: 10.1016/j.ajem.2016.05.071. Epub 2016 May 29.
INTRODUCTION
Right ventricular (RV) dysfunction has proved to be an important predictor of morbidity and mortality in patients with pulmonary embolism (PE). Tricuspid annular plane systolic excursion (TAPSE) is one of the parameters that have been validated as predictor of outcomes. The aim of our study was to evaluate the performance (sensitivity and specificity) of high-sensitivity cardiac troponin T (hs-cTnT) to predict RV dysfunction defined as TAPSE <16 mm.
METHODS
We conducted a single-center retrospective analysis of 40 patients prospectively included. Median age was 66 years (59-76) and PESI score was 81 (67-100).
RESULTS
Right ventricular dysfunction was present in 30% of the patients and was associated with higher median troponin values (33.5 ng/L vs 16 ng/L; P= .03). A logarithmic relation was observed between hs-cTnT and lower TAPSE values (r(2)= 0.36; P< .0001). The area under the ROC curve of hs-cTnT to predict RV dysfunction was 0.77 (0.63-0.92).
CONCLUSION
hs-cTnT is a biomarker with good performance to identify RV dysfunction in PE.
引言
右心室（RV）功能障碍已被证明是肺栓塞（PE）患者发病和死亡的重要预测指标。三尖瓣环平面收缩期位移（TAPSE）是已被证实可作为预后预测指标的参数之一。我们研究的目的是评估高敏心肌肌钙蛋白T（hs-cTnT）预测定义为TAPSE<16mm的右心室功能障碍的性能（敏感性和特异性）。
方法
我们对40例前瞻性纳入的患者进行了单中心回顾性分析。中位年龄为66岁（59-76岁），PESI评分为81分（67-100分）。
结果
30%的患者存在右心室功能障碍，且与较高的肌钙蛋白中位数水平相关（33.5ng/L对16ng/L；P=0.03）。观察到hs-cTnT与较低的TAPSE值之间存在对数关系（r²=0.36；P<0.0001）。hs-cTnT预测右心室功能障碍的ROC曲线下面积为0.77（0.63-0.92）。
结论
hs-cTnT是一种在识别PE患者右心室功能障碍方面具有良好性能的生物标志物。
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