高敏肌钙蛋白 T 和 AXL 可溶性形式作为心脏移植后的长期预后生物标志物。
High-Sensitivity Troponin T and Soluble Form of AXL as Long-Term Prognostic Biomarkers after Heart Transplantation.
机构信息
Cardiology Department, Hospital Santa Creu i Sant Pau, CIBERCV, Barcelona, Spain.
IBB-Sant Pau, Barcelona, Spain.
出版信息
Dis Markers. 2018 Aug 29;2018:6243529. doi: 10.1155/2018/6243529. eCollection 2018.
ANTECEDENTS
Cardiac allograft vasculopathy (CAV) is a frequent complication limiting the long-term (>1 year) survival after heart transplantation (HTx). CAV is initiated by endothelial dysfunction and can lead to severe cardiovascular (CV) complications. Since CAV is often clinically silent, biomarkers could help identifying HTx patients at risk of CAV and their severe complications.
AIM
Evaluate the clinical yield of high-sensitivity cardiac troponin T (hs-cTnT), marker of cardiomyocyte damage, and the soluble form of AXL (sAXL), biomarker of endothelial dysfunction, to assess the prognosis of long-term cardiovascular (CV) events occurring after HTx.
METHODS
96 patients were evaluated at least > 1 year after HTx. CAV was evaluated by coronary angiography or multisliced tomography, and hs-cTnT and sAXL measured 6 months before or after CAV evaluation. Patients were followed during 42 ± 15 months for a combined end point including cardiac death, angina or acute myocardial infarction, left ventricular ejection fraction < 50%, or heart failure not due to an acute rejection.
RESULTS
51 patients (53%) presented CAV at evaluation; 21 of them had CV events. Hs-cTnT (56 ± 45 versus 20 ± 18 ng/L; = 0.04) and sAXL concentrations (98 ± 51 versus 26 ± 26 ng/L; = 0.01) were significantly higher in patients with CV events. Hs-cTnT (HR 1.03; 95% CI 1.015-1.042, = 0.0001) and sAXL (HR 1.01; 95% CI 1.001-1.019, = 0.02) were independent predictors of CV events. A hs-cTnT concentration < 21 ng/L, detected by AUC ROC, predicted the absence of CV events with a predictive value of 91%; sAXL did not add more predictive value to hs-cTnT. Survival free of CV events was 92% in patients with hs-cTnT < 21 ng/L and 57% in those with hs-cTnT > 21 ng/L ( < 0.001).
CONCLUSION
Hs-cTnT, but not sAXL, measured during the long-term follow-up of HTx patients appears as a helpful biomarker to identify patients at low risk of adverse CV outcomes.
背景
心脏同种异体移植物血管病（CAV）是心脏移植（HTx）后限制长期（>1 年）生存的常见并发症。CAV 由内皮功能障碍引发，并可导致严重的心血管（CV）并发症。由于 CAV 通常在临床上没有症状，因此生物标志物可以帮助识别有发生 CAV 及其严重并发症风险的 HTx 患者。
目的
评估高敏心肌肌钙蛋白 T（hs-cTnT），即心肌细胞损伤标志物，以及可溶性 AXL（sAXL），即内皮功能障碍的生物标志物的临床价值，以评估 HTx 后发生的长期心血管（CV）事件的预后。
方法
对至少>1 年后进行 HTx 的 96 例患者进行评估。通过冠状动脉造影或多排螺旋 CT 评估 CAV，在 CAV 评估前或后 6 个月测量 hs-cTnT 和 sAXL。在 42±15 个月的时间内对患者进行随访，终点包括心脏死亡、心绞痛或急性心肌梗死、左心室射血分数<50%或非急性排斥引起的心衰。
结果
51 例（53%）患者在评估时出现 CAV；其中 21 例发生 CV 事件。hs-cTnT（56±45 比 20±18ng/L； = 0.04）和 sAXL 浓度（98±51 比 26±26ng/L； = 0.01）在发生 CV 事件的患者中明显更高。hs-cTnT（HR 1.03；95%CI 1.015-1.042， = 0.0001）和 sAXL（HR 1.01；95%CI 1.001-1.019， = 0.02）是 CV 事件的独立预测因子。通过 AUC ROC 检测到 hs-cTnT 浓度<21ng/L，可预测 CV 事件的不存在，其预测值为 91%；sAXL 对 hs-cTnT 无额外预测价值。hs-cTnT<21ng/L 的患者无 CV 事件的生存率为 92%，而 hs-cTnT>21ng/L 的患者为 57%（<0.001）。
结论
在 HTx 患者的长期随访中，hs-cTnT 而非 sAXL 似乎是一种有用的生物标志物，可识别发生不良 CV 结局风险较低的患者。
Zotero 插件