Nordin A, Svenungsson E, Björnådal L, Elvin K, Larsson A, Jensen-Urstad K
a Rheumatology Unit, Department of Medicine, Solna , Karolinska University Hospital, Karolinska Institutet , Stockholm , Sweden.
b Unit of Clinical Immunology, Department of Clinical Immunology and Transfusion Medicine , Karolinska University Hospital, Karolinska Institutet , Stockholm , Sweden.
Scand J Rheumatol. 2017 May;46(3):226-235. doi: 10.1080/03009742.2016.1192217. Epub 2016 Sep 7.
Cardiac manifestations in systemic sclerosis (SSc) are associated with poor prognosis. Few studies have investigated cardiac troponins in SSc. We studied the relationships between echocardiographic abnormalities, cardiac biomarkers, and disease manifestations in a population-based cohort of patients with SSc and controls.
The study comprised 110 patients with SSc and 105 age- and sex-matched population-based controls. We examined ventricular function, heart valves, and estimated pulmonary arterial pressure (ePAP) by echocardiography in all participants. Disease characteristics, manifest ischaemic heart disease (IHD), and measurements of N-terminal prohormone brain natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin I (hs-cTnI) were tabulated.
NT-proBNP and hs-cTnI levels were higher in SSc patients than controls. Both NT-proBNP and hs-cTnI were associated with the presence of echocardiographic abnormalities. Forty-four SSc patients and 23 control subjects had abnormal echocardiograms (p = 0.002). As a group, SSc patients had lower (but normal) left ventricular ejection fraction (LVEF, p = 0.02), more regional hypokinesia (p = 0.02), and more valve regurgitations (p = 0.01) than controls. Thirteen patients and four controls had manifest IHD. Decreased right ventricular (RV) function (n = 7) and elevated ePAP (n = 15) were exclusively detected among SSc patients.
Both NTproBNP and hs-cTnI were associated with echocardiographic abnormalities, which were more prevalent in SSc patients than in controls. Our results thus suggest that hs-cTnI could be a potential cardiac biomarker in SSc. Low RV function and signs of pulmonary hypertension (PH) were uniquely found in the SSc group. SSc patients had more valve regurgitation than controls, an observation that warrants more clinical attention.
系统性硬化症（SSc）的心脏表现与预后不良相关。很少有研究调查SSc患者的心肌肌钙蛋白。我们在一个基于人群的SSc患者队列和对照组中研究了超声心动图异常、心脏生物标志物与疾病表现之间的关系。
该研究包括110例SSc患者和105例年龄及性别匹配的基于人群的对照组。我们通过超声心动图检查了所有参与者的心室功能、心脏瓣膜，并估计了肺动脉压（ePAP）。记录疾病特征、显性缺血性心脏病（IHD）以及N末端脑钠肽前体（NT-proBNP）和高敏心肌肌钙蛋白I（hs-cTnI）的测量值。
SSc患者的NT-proBNP和hs-cTnI水平高于对照组。NT-proBNP和hs-cTnI均与超声心动图异常的存在相关。44例SSc患者和23例对照者的超声心动图异常（p = 0.002）。总体而言，SSc患者的左心室射血分数（LVEF）低于（但正常）对照组（p = 0.02），节段性运动减弱更多（p = 0.02），瓣膜反流更多（p = 0.01）。13例患者和4例对照者有显性IHD。仅在SSc患者中检测到右心室（RV）功能下降（n = 7）和ePAP升高（n = 15）。
NT-proBNP和hs-cTnI均与超声心动图异常相关，超声心动图异常在SSc患者中比对照组更普遍。因此，我们的结果表明hs-cTnI可能是SSc中一种潜在的心脏生物标志物。在SSc组中独特地发现了低RV功能和肺动脉高压（PH）的迹象。SSc患者的瓣膜反流比对照组更多，这一观察结果值得更多临床关注。
