Acosta Giancarlo, Amro Ahmed, Aguilar Rodrigo, Abusnina Waiel, Bhardwaj Niharika, Koromia George Augustine, Studeny Mark, Irfan Affan
Cardiology, Marshall University, Huntington, USA.
Internal Medicine, Marshall University, Joan C. Edwards School of Medicine, Huntington, USA.
Cureus. 2020 Jan 27;12(1):e6787. doi: 10.7759/cureus.6787.
Introduction There is a high prevalence of hypertensive crisis with myocardial injury, as evidenced by elevation in cardiac troponin levels. The risk factors predisposing patients to developing a myocardial injury, detectable troponin, and increase in serial troponin in this population are not known. Methods A retrospective study was designed to include all patients, presenting to the emergency room, diagnosed with hypertensive crisis, using International Classification of Diseases, 10 revision, Clinical Modification (ICD-10-CM) codes between 2016-2018 (n=467). Logistic regression was used to determine the important predictors of myocardial injury evidenced by troponin elevation >99 percentile of upper reference level (URL), detectable troponin (> 0.015 ng/ml), and increase in serial troponin levels. Results The 99 percentile of the initial troponin level among all patients was 0.433 ng/ml. A total of 15% had a myocardial injury, and the significant risk factors associated with it were body mass index (BMI) < 30 kg/m2 (odds ratio [OR] 0.50, confidence interval [CI] 0.28-0.89), congestive heart failure (CHF; OR 4.28, CI 2.21-8.25) and prior use of aspirin (OR 1.98, CI 1.08-3.63). About 35% had detectable troponin, and BMI < 30 kg/m (OR 0.62, CI 0.40-0.97), CHF (OR 3.49, CI 2.06-5.9), elevated creatinine (OR 1.17, CI 1.02-1.34) and age <61 years (OR 0.59, CI 0.38-0.94) were associated with it. The factors associated with an increase in serial troponin were BMI < 30 Kg/m2 (OR 0.56, CI 0.36-0.87), CHF (OR 1.78, CI 1.06-3.0), coronary artery disease (CAD; OR 2.08, CI 1.28-3.36) and non-Caucasian race (OR 0.52, CI 0.29-0.93). Conclusion About one-third of patients with the hypertensive crisis have detectable troponin. Still, among these, less than half have troponin levels >99 percentile URL, and the majority of these patients have minimal changes in serial troponin. Low BMI was associated with higher initial and serial troponin levels, and this obesity paradox was stronger among females and older patients.
引言 高血压危象合并心肌损伤的患病率很高，心肌肌钙蛋白水平升高证明了这一点。目前尚不清楚导致该人群发生心肌损伤、可检测到肌钙蛋白以及系列肌钙蛋白升高的危险因素。方法 一项回顾性研究纳入了2016年至2018年间使用国际疾病分类第10次修订版临床修订本（ICD-10-CM）编码诊断为高血压危象并前往急诊室就诊的所有患者（n = 467）。采用逻辑回归确定肌钙蛋白升高>参考上限（URL）的第99百分位数、可检测到的肌钙蛋白（>0.015 ng/ml）以及系列肌钙蛋白水平升高所证明的心肌损伤的重要预测因素。结果 所有患者初始肌钙蛋白水平的第99百分位数为0.433 ng/ml。共有15%的患者发生心肌损伤，与之相关的显著危险因素为体重指数（BMI）<30 kg/m2（比值比[OR] 0.50，置信区间[CI] 0.28 - 0.89）、充血性心力衰竭（CHF；OR 4.28，CI 2.21 - 8.25）以及既往使用阿司匹林（OR 1.98，CI 1.08 - 3.63）。约35%的患者可检测到肌钙蛋白，BMI <30 kg/m（OR 0.62，CI 0.40 - 0.97）、CHF（OR 3.49，CI 2.06 - 5.9）、肌酐升高（OR 1.17，CI 1.02 - 1.34）以及年龄<61岁（OR 0.59，CI 0.38 - 0.94）与之相关。与系列肌钙蛋白升高相关的因素为BMI <30 Kg/m2（OR 0.56，CI 0.36 - 0.87）、CHF（OR 1.78，CI 1.06 - 3.0）、冠状动脉疾病（CAD；OR 2.08，CI 1.28 - 3.36）以及非白种人（OR 0.52，CI 0.29 - 0.93）。结论 约三分之一的高血压危象患者可检测到肌钙蛋白。然而，在这些患者中，不到一半的患者肌钙蛋白水平>URL的第99百分位数，且这些患者中的大多数系列肌钙蛋白变化极小。低BMI与较高的初始和系列肌钙蛋白水平相关，这种肥胖悖论在女性和老年患者中更为明显。
