N端前体B型利钠肽及高敏心肌肌钙蛋白T水平与缺血性心力衰竭患者冬眠心肌范围相关。

N-Terminal Pro B-Type Natriuretic Peptide and High-Sensitivity Cardiac Troponin T Levels Are Related to the Extent of Hibernating Myocardium in Patients With Ischemic Heart Failure.

作者信息

Zelt Jason G E, Liu Peter P, Erthal Fernanda, deKemp Robert A, Wells George, O'Meara Eileen, Garrard Linda, Beanlands Rob S B, Mielniczuk Lisa M

机构信息

Molecular Function and Imaging Program, The National Cardiac PET Centre, and the Advanced Heart Disease Program, Division of Cardiology, Department of Medicine, and the Cardiac Research Methods Centre, University of Ottawa Heart Institute and University of Ottawa, Ottawa, Ontario, Canada; Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.

出版信息

Can J Cardiol. 2017 Nov;33(11):1478-1488. doi: 10.1016/j.cjca.2017.06.012. Epub 2017 Jun 27.

DOI:10.1016/j.cjca.2017.06.012

PMID:28966019

Abstract

BACKGROUND

Increased N-terminal pro b-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT) can identify patients with heart failure (HF) who are at increased risk of cardiac events. The relationship of these biomarkers to the extent of hibernating myocardium and scar has not been previously characterized in patients with ischemic left ventricular dysfunction and HF.

METHODS

Patients with ischemic HF meeting recruitment criteria and undergoing perfusion and fluorodeoxyglucose-positron emission tomography to define myocardial hibernation and scar were included in the study. A total of 39 patients (mean age 67 ± 8 years) with New York Heart Association class II-IV HF and ischemic cardiomyopathy (ejection fraction [EF], 27.9% ± 8.5%) were enrolled in the study.

RESULTS

Serum NT-proBNP and hs-cTnT levels were elevated in patients with ≥ 10% hibernating myocardium compared with those with < 10% (NT-pro-BNP, 7419.10 ± 7169.5 pg/mL vs 2894.6 ± 2967.4 pg/mL; hs-cTnT, 789.3 ± 1835.3 pg/mL vs 44.8 ± 78.9 pg/mL; P < 0.05). The overall receiver operating characteristic under the curve value for NT-proBNP and hs-cTnT to predict hibernating myocardium was 0.76 and 0.78, respectively (P < 0.05). The NT-proBNP (P = 0.02) and hs-cTnT (P < 0.0001) levels also correlated with hibernation, particularly in patients with ≥ 10% scar, independent of EF, age, and estimated glomerular filtration rate. No differences were noted in biomarker levels for patients with vs those without ≥ 10% scar.

CONCLUSIONS

NT-proBNP and hs-cTnT levels are elevated in patients with ischemic HF hibernation and are correlated with the degree of hibernation but not with the presence or extent of scar. Taken together, these data support the novel concept that NT-proBNP and hs-cTnT release in patients with ischemic HF reflects the presence and extent of hibernating myocardium.

摘要

背景

N 末端 B 型利钠肽原（NT-proBNP）升高和高敏心肌肌钙蛋白 T（hs-cTnT）升高可识别心脏事件风险增加的心力衰竭（HF）患者。在缺血性左心室功能障碍和 HF 患者中，这些生物标志物与冬眠心肌和瘢痕范围的关系此前尚未得到描述。

方法

纳入符合招募标准并接受灌注和氟脱氧葡萄糖-正电子发射断层扫描以确定心肌冬眠和瘢痕的缺血性 HF 患者。共有 39 例纽约心脏协会 II-IV 级 HF 和缺血性心肌病（射血分数[EF]，27.9%±8.5%）患者（平均年龄 67±8 岁）纳入本研究。

结果

与冬眠心肌<10%的患者相比，冬眠心肌≥10%的患者血清 NT-proBNP 和 hs-cTnT 水平升高（NT-proBNP，7419.10±7169.5 pg/mL 对 2894.6±2967.4 pg/mL；hs-cTnT，789.3±1835.3 pg/mL 对 44.8±78.9 pg/mL；P<0.05）。NT-proBNP 和 hs-cTnT 预测冬眠心肌的曲线下总体受试者工作特征值分别为 0.76 和 0.78（P<0.05）。NT-proBNP（P = 0.02）和 hs-cTnT（P<0.0001）水平也与冬眠相关，特别是在瘢痕≥10%的患者中，与 EF、年龄和估计肾小球滤过率无关。有≥10%瘢痕和无≥10%瘢痕的患者生物标志物水平无差异。