高敏心肌肌钙蛋白 T 与运动负荷试验评估有临床意义的冠状动脉疾病。
High-sensitive cardiac Troponin T and exercise stress test for evaluation of angiographically significant coronary disease.
机构信息
Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital Ullevaal, Norway; Faculty of Medicine, University of Oslo, Norway; Section of Cardiovascular and Renal Research Oslo University Hospital Ullevaal, Norway.
Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital Ullevaal, Norway; Department of Cardiology, Oslo University Hospital Ullevaal, Norway; Faculty of Medicine, University of Oslo, Norway.
出版信息
Int J Cardiol. 2019 Jul 15;287:1-6. doi: 10.1016/j.ijcard.2019.04.019. Epub 2019 Apr 8.
BACKGROUND
Exercise stress test (EST) has a moderate precision for diagnosis of CAD and could potentially obtain improved accuracy if adding a reliable cardiac biomarker to the test.
OBJECTIVE
We aimed to investigate resting levels and change in hs-cTnT during EST in patients with and without angiographically significant CAD. Moreover, we intended to explore the additive value of hs-cTnT to EST results in diagnosis of stable CAD. We hypothesized that hs-cTnT would be higher in CAD patients and increase diagnostic precision of EST.
METHOD
Patients presenting with symptoms of stable CAD, performed a maximal EST on a bicycle ergometer. Venous blood samples were taken at rest and within 5 min post-exercise. All patients underwent coronary angiography. Significant CAD was defined as having ≥75% stenosis in one or more segments of the coronary arteries.
RESULTS
Out of the 297 participants, significant CAD was found in 111 (37%) patients. Patients with significant CAD compared to without, had higher resting levels of hs-cTnT (median 8.1 vs 5.0 ng/L) and no significant difference in exercise-induced change (median 0.5 vs 0.3 ng/L), p < 0.001 and p = 0.086 respectively. Combined resting hs-cTnT with EST had higher predictive value for significant CAD than EST alone, AUC = 0.751 vs. AUC = 0.637. In an adjusted multivariable regression analysis, resting hs-cTnT >6.0 ng/L was predictive for having significant CAD, OR 2.55 (CI 95% 1.40, 4.65 p = 0.002).
CONCLUSION
In patients with suspected stable CAD, hs-cTnT has a predictive value alone, as well as added to a diagnostic EST for CAD.
背景
运动压力测试（EST）对 CAD 的诊断具有中等的准确性，如果将可靠的心脏生物标志物添加到测试中，可能会获得更高的准确性。
目的
我们旨在研究有无造影显著 CAD 患者在 EST 期间静息 hs-cTnT 水平和变化。此外，我们还旨在探索 hs-cTnT 对 EST 结果在稳定 CAD 诊断中的附加价值。我们假设 hs-cTnT 在 CAD 患者中更高，并提高 EST 的诊断精度。
方法
出现稳定型 CAD 症状的患者在自行车测功机上进行最大 EST。在休息时和运动后 5 分钟内采集静脉血样。所有患者均接受冠状动脉造影。有意义的 CAD 定义为一条或多条冠状动脉的一个或多个节段有≥75%的狭窄。
结果
在 297 名参与者中，有 111 名（37%）患者发现有显著 CAD。与无显著 CAD 患者相比，有显著 CAD 患者的静息 hs-cTnT 水平更高（中位数 8.1 比 5.0ng/L），而运动诱导的变化无显著差异（中位数 0.5 比 0.3ng/L），p<0.001 和 p=0.086。与单独 EST 相比，结合静息 hs-cTnT 和 EST 具有更高的预测显著 CAD 的价值，AUC=0.751 比 AUC=0.637。在调整后的多变量回归分析中，静息 hs-cTnT>6.0ng/L 是有显著 CAD 的预测因子，OR 2.55（95%CI 1.40，4.65，p=0.002）。
结论
在疑似稳定型 CAD 的患者中，hs-cTnT 单独具有预测价值，也可作为 CAD 诊断的 EST 的附加指标。
Zotero 插件