疑似稳定型心绞痛患者的心肌肌钙蛋白 T 浓度、可逆性心肌缺血和左心室重构指数：一项多普勒 CIP 亚研究。

Cardiac Troponin T Concentrations, Reversible Myocardial Ischemia, and Indices of Left Ventricular Remodeling in Patients with Suspected Stable Angina Pectoris: a DOPPLER-CIP Substudy.

机构信息

Division of Medicine, Akershus University Hospital, Lørenskog, Norway and Center for Heart Failure Research, University of Oslo, Oslo, Norway.

Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.

出版信息

Clin Chem. 2018 Sep;64(9):1370-1379. doi: 10.1373/clinchem.2018.288894. Epub 2018 Jun 29.

DOI:10.1373/clinchem.2018.288894

PMID:29959147

Abstract

BACKGROUND

Cardiac troponin T concentrations measured with high-sensitivity assays (hs-cTnT) provide important prognostic information for patients with stable coronary artery disease (CAD). However, whether hs-cTnT concentrations mainly reflect left ventricular (LV) remodeling or recurrent myocardial ischemia in this population is not known.

METHODS

We measured hs-cTnT concentrations in 619 subjects with suspected stable CAD in a prospectively designed multicenter study. We identified associations with indices of LV remodeling, as assessed by cardiac MRI and echocardiography, and evidence of myocardial ischemia diagnosed by single positron emission computed tomography.

RESULTS

Median hs-cTnT concentration was 7.8 ng/L (interquartile range, 4.8-11.6 ng/L), and 111 patients (18%) had hs-cTnT concentrations above the upper reference limit (>14 ng/L). Patients with hs-cTnT >14 ng/L had increased LV mass (144 ± 40 g vs 116 ± 34 g; < 0.001) and volume (179 ± 80 mL vs 158 ± 44 mL; = 0.006), lower LV ejection fraction (LVEF) (59 ± 14 vs 62 ± 11; = 0.006) and global longitudinal strain (14.1 ± 3.4% vs 16.9 ± 3.2%; < 0.001), and more reversible perfusion defects ( = 0.001) and reversible wall motion abnormalities ( = 0.008). Age ( = 0.009), estimated glomerular filtration rate ( = 0.01), LV mass ( = 0.003), LVEF ( = 0.03), and evidence of reversible myocardial ischemia ( = 0.004 for perfusion defects and = 0.02 for LV wall motion) were all associated with increasing hs-cTnT concentrations in multivariate analysis. We found analogous results when using the revised US upper reference limit of 19 ng/L.

CONCLUSIONS

hs-cTnT concentrations reflect both LV mass and reversible myocardial ischemia in patients with suspected stable CAD.

摘要

背景

采用高敏检测方法（hs-cTnT）测量的心肌肌钙蛋白 T 浓度为稳定性冠心病（CAD）患者提供了重要的预后信息。然而，在这一人群中，hs-cTnT 浓度主要反映左心室（LV）重构还是复发性心肌缺血尚不清楚。

方法

我们在一项前瞻性设计的多中心研究中测量了 619 例疑似稳定性 CAD 患者的 hs-cTnT 浓度。我们通过心脏 MRI 和超声心动图评估 LV 重构指标，并通过单光子发射计算机断层扫描（SPECT）诊断心肌缺血。

结果

中位 hs-cTnT 浓度为 7.8ng/L（四分位间距 4.8-11.6ng/L），111 例（18%）患者的 hs-cTnT 浓度高于上限参考值（>14ng/L）。hs-cTnT>14ng/L 的患者 LV 质量（144±40g 比 116±34g；<0.001）和容量（179±80mL 比 158±44mL；=0.006）更大，左心室射血分数（LVEF）（59±14 比 62±11；=0.006）和整体纵向应变（GLS）（14.1±3.4% 比 16.9±3.2%；<0.001）更低，并且存在更多的可逆性灌注缺陷（=0.001）和可逆性壁运动异常（=0.008）。多变量分析显示，年龄（=0.009）、估算肾小球滤过率（=0.01）、LV 质量（=0.003）、LVEF（=0.03）和可逆性心肌缺血证据（灌注缺陷为=0.004，LV 壁运动异常为=0.02）均与 hs-cTnT 浓度的升高相关。当使用美国修订的上限参考值 19ng/L 时，我们发现了类似的结果。