Divisions of Cardiology, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland.
Divisions of Nephrology, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland.
Am J Cardiol. 2020 Dec 1;136:156-163. doi: 10.1016/j.amjcard.2020.09.013. Epub 2020 Sep 16.
High sensitivity cardiac troponin T (hscTnT), soluble ST2 (sST2), N-terminal B-type natriuretic peptide (NT-proBNP), and galectin-3 are biomarkers of cardiac injury, stress, myocardial stretch, and fibrosis. Elevated levels are associated with poor outcomes. However, their association with cardiac mechanics in older persons is unknown. Associations between these biomarkers and cardiac mechanics derived from speckle tracking echocardiography, including left ventricular longitudinal strain (LVLS), early diastolic strain, and left atrial reservoir strain (LARS) were evaluated using standardized beta coefficients () in a cross sectional analysis with cardiac biomarkers in older patients without cardiovascular disease, low ejection fraction, or wall motion abnormalities. Biomarker associations with strain were attenuated by demographics and risk factors. In adjusted models, LVLS was associated with continuous measures of hscTnT (β-0.06, p = 0.020), sST2 (β -0.05, p = 0.024) and NT-proBNP (β -0.06, p = 0.007). "High" levels (i.e., greater than prognostic cutpoint) of hscTnT (>13 ng/ml), sST2 (>35 ng/ml), and NT-proBNP (>190 pg/ml) were also associated with worse LVLS. In risk factor adjusted models, LARS was associated with hscTnT (β -0.08, p = 0.003) and NT-proBNP (β-0.18, p <0.0001). High hscTnT (>13 ng/ml) and high NT-proBNP (>190 pg/ml) were also both associated with worse LARS. Gal-3 was not associated with any strain measure. In conclusion, in persons ≥ 65 years of age, without cardiovascular disease, low ejection fraction, or wall motion abnormalities, hscTnT, sST2, and NT-proBNP are associated with worse LVLS. HscTnT and NT-proBNP are associated with worse LARS. In conclusion, these subclinical increases in blood biomarkers, and their associations with subtle diastolic and systolic dysfunction, may represent pre-clinical heart failure.
高敏心肌肌钙蛋白 T（hscTnT）、可溶性 ST2（sST2）、N 末端 B 型利钠肽前体（NT-proBNP）和半乳糖凝集素-3 是心脏损伤、应激、心肌拉伸和纤维化的生物标志物。这些标志物水平升高与不良预后相关。然而，它们与老年人心脏力学的关系尚不清楚。在无心血管疾病、射血分数低或室壁运动异常的老年患者中，使用斑点追踪超声心动图获得的心脏力学与这些生物标志物的横断面分析评估了这些标志物与左心室纵向应变（LVLS）、早期舒张应变和左心房储备应变（LARS）之间的关系，使用标准化β系数（β）。生物标志物与应变的相关性被人口统计学和危险因素所减弱。在调整后的模型中，LVLS 与 hscTnT 的连续测量值相关（β-0.06，p=0.020）、sST2（β-0.05，p=0.024）和 NT-proBNP（β-0.06，p=0.007）。hscTnT（>13ng/ml）、sST2（>35ng/ml）和 NT-proBNP（>190pg/ml）的“高”水平（即大于预后切点）也与较差的 LVLS 相关。在危险因素调整模型中，LARS 与 hscTnT（β-0.08，p=0.003）和 NT-proBNP（β-0.18，p<0.0001）相关。高 hscTnT（>13ng/ml）和高 NT-proBNP（>190pg/ml）也与较差的 LARS 相关。Gal-3 与任何应变指标均无关。结论：在年龄≥65 岁、无心血管疾病、射血分数低或室壁运动异常的患者中，hscTnT、sST2 和 NT-proBNP 与较差的 LVLS 相关。hscTnT 和 NT-proBNP 与较差的 LARS 相关。总之，这些血液生物标志物的亚临床升高及其与细微舒张和收缩功能障碍的关系，可能代表临床前心力衰竭。
