Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Multidisciplinary Laboratory Medicine and Medical Biochemistry, Akershus University Hospital, Lørenskog, Norway.
Clin Biochem. 2021 Feb;88:30-36. doi: 10.1016/j.clinbiochem.2020.11.009. Epub 2020 Nov 25.
To assess if cardiac troponins can improve diagnostics of acute heart failure (AHF) and provide prognostic information in patients with acute dyspnea.
We measured cardiac troponin T with a high-sensitivity assay (hs-cTnT) in 314 patients hospitalized with acute dyspnea. The index diagnosis was adjudicated and AHF patients were stratified into AHF with reduced or preserved ejection fraction (HFrEF/HFpEF). The prognostic and diagnostic merit of hs-cTnT was compared to the merit of N-terminal pro-B-type natriuretic peptide (NT-proBNP).
In the total population, median age was 73 (quartile [Q] 1-3 63-81) years and 48% were women. One-hundred-forty-three patients were categorized as AHF (46%) and these patients had higher hs-cTnT concentrations than patients with non-AHF-related dyspnea: median 38 (Q1-3 22-75) vs. 13 (4-25) ng/L; p < 0.001. hs-cTnT concentrations were similar between patients with HFrEF and HFpEF (p = 0.80), in contrast to NT-proBNP, which was higher in HFrEF (p < 0.001). C-statistics for discriminating HFpEF from non-AHF-related dyspnea was 0.80 (95% CI 0.73-0.86) for hs-cTnT, 0.79 (0.73-0.86) for NT-proBNP, and 0.83 (0.76-0.89) for hs-cTnT and NT-proBNP in combination. Elevated hs-cTnT remained associated with HFpEF in logistic regression analysis after adjusting for demographics, comorbidities and renal function. During median 27 months of follow-up, 114 (36%) patients died in the total population. Higher hs-cTnT concentrations were associated with increased risk of all-cause mortality after adjustment for clinical variables and NT-proBNP: hazard ratio 1.30 (95% CI 1.07-1.58), p = 0.009.
hs-cTnT measurements improve diagnostic accuracy for HFpEF and provide independent prognostic information in unselected patients with acute dyspnea.
评估心脏肌钙蛋白是否可以改善急性心力衰竭（AHF）的诊断，并为急性呼吸困难患者提供预后信息。
我们使用高敏检测法（hs-cTnT）检测了 314 名因急性呼吸困难住院的患者的心脏肌钙蛋白 T。对指标诊断进行裁决，并将 AHF 患者分为射血分数降低型心力衰竭（HFrEF）/射血分数保留型心力衰竭（HFpEF）。将 hs-cTnT 的诊断和预后价值与 N 末端脑钠肽前体（NT-proBNP）的价值进行比较。
在总人群中，中位年龄为 73（四分位距 1-3 为 63-81）岁，48%为女性。143 名患者被归类为 AHF（46%），这些患者的 hs-cTnT 浓度高于非 AHF 相关呼吸困难患者：中位数为 38（四分位距 1-3 为 22-75）比 13（4-25）ng/L；p<0.001。HFrEF 与 HFpEF 患者的 hs-cTnT 浓度相似（p=0.80），而 NT-proBNP 则较高（p<0.001）。hs-cTnT 区分 HFpEF 与非 AHF 相关呼吸困难的 C 统计量为 0.80（95%CI 0.73-0.86），NT-proBNP 为 0.79（0.73-0.86），hs-cTnT 和 NT-proBNP 联合检测为 0.83（0.76-0.89）。在校正人口统计学、合并症和肾功能后，hs-cTnT 在逻辑回归分析中仍与 HFpEF 相关。在中位 27 个月的随访期间，总人群中有 114 名（36%）患者死亡。校正临床变量和 NT-proBNP 后，较高的 hs-cTnT 浓度与全因死亡率增加相关：危险比 1.30（95%CI 1.07-1.58），p=0.009。
hs-cTnT 测量可提高 HFpEF 的诊断准确性，并为急性呼吸困难的未选择患者提供独立的预后信息。
