高敏心肌肌钙蛋白与新发心力衰竭：4165 例新发心力衰竭事件、67063 例患者的系统评价和荟萃分析。
High-Sensitivity Cardiac Troponin and New-Onset Heart Failure: A Systematic Review and Meta-Analysis of 67,063 Patients With 4,165 Incident Heart Failure Events.
机构信息
Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom; Transplant Unit, Papworth Hospitals NHS Foundation Trust, Papworth Everard, Cambridge, United Kingdom.
Department of Cardiology, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom.
出版信息
JACC Heart Fail. 2018 Mar;6(3):187-197. doi: 10.1016/j.jchf.2017.11.003. Epub 2018 Jan 10.
OBJECTIVES
The aim of this study was to systematically collate and appraise the available evidence regarding the association between high-sensitivity cardiac troponin (hs-cTn) and incident heart failure (HF) and the added value of hs-cTn in HF prediction.
BACKGROUND
Identification of subjects at high risk for HF and early risk factor modification with medications such as angiotensin-converting enzyme inhibitors may delay the onset of HF. Hs-cTn has been suggested as a prognostic marker for the incidence of first-ever HF in asymptomatic subjects.
METHODS
PubMed, Embase, and Web of Science were systematically searched for prospective cohort studies published before January 2017 that reported associations between hs-cTn and incident HF in subjects without baseline HF. Study-specific multivariate-adjusted hazard ratios (HRs) were pooled using random-effects meta-analysis.
RESULTS
Data were collated from 16 studies with a total of 67,063 subjects and 4,165 incident HF events. The average age was 57 years, and 47% were women. Study quality was high (Newcastle-Ottawa score 8.2 of 9). In a comparison of participants in the top third with those in the bottom third of baseline values of hs-cTn, the pooled multivariate-adjusted HR for incident HF was 2.09 (95% confidence interval [CI]: 1.76 to 2.48; p < 0.001). Between-study heterogeneity was high, with an I value of 80%. HRs were similar in men and women (2.29 [95% CI: 1.64 to 3.21] vs. 2.18 [95% CI: 1.68 to 2.81]) and for hs-cTnI and hs-cTnT (2.09 [95% CI: 1.53 to 2.85] vs. 2.11 [95% CI: 1.69 to 2.63]) and across other study-level characteristics. Further adjustment for B-type natriuretic peptide yielded a similar HR of 2.08 (95% CI: 1.64 to 2.65). Assay of hs-cTn in addition to conventional risk factors provided improvements in the C index of 1% to 3%.
CONCLUSIONS
Available prospective studies indicate a strong association of hs-cTn with the risk of first-ever HF and significant improvements in HF prediction.
目的
本研究旨在系统地整理和评估有关高敏心肌肌钙蛋白（hs-cTn）与心力衰竭（HF）事件之间关联的现有证据，以及 hs-cTn 对 HF 预测的增值作用。
背景
识别 HF 高危人群并早期使用药物（如血管紧张素转换酶抑制剂）进行危险因素干预可能会延迟 HF 的发生。hs-cTn 已被提议作为无症状受试者首次 HF 事件的预后标志物。
方法
系统检索了截至 2017 年 1 月之前发表的前瞻性队列研究，这些研究报告了无基线 HF 的受试者中 hs-cTn 与 HF 事件之间的关联。使用随机效应荟萃分析汇总了基于研究的多变量调整后的风险比（HR）。
结果
纳入了 16 项研究，共纳入 67063 名受试者和 4165 例 HF 事件。受试者的平均年龄为 57 岁，其中 47%为女性。研究质量较高（新奥尔良评分 8.2 分）。在比较 hs-cTn 基线值最高的三分之一与最低的三分之一的受试者时，HF 事件的多变量调整后 HR 为 2.09（95%置信区间[CI]：1.76 至 2.48；p<0.001）。研究间异质性较高，I ² 值为 80%。男性和女性的 HR 相似（2.29 [95% CI：1.64 至 3.21] vs. 2.18 [95% CI：1.68 至 2.81]），hs-cTnI 和 hs-cTnT 的 HR 也相似（2.09 [95% CI：1.53 至 2.85] vs. 2.11 [95% CI：1.69 至 2.63]），且在其他研究水平特征中也是如此。进一步调整 B 型利钠肽（BNP）后，HR 相似为 2.08（95% CI：1.64 至 2.65）。在常规危险因素的基础上增加 hs-cTn 检测，可使 C 指数提高 1%至 3%。
结论
现有前瞻性研究表明，hs-cTn 与首次 HF 风险具有很强的相关性，并显著改善了 HF 预测。
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