Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; Institute of Preventive Pediatrics, Technische Universität München, Georg-Brauchle-Ring 60/62, 80992 Munich, Germany.
Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
J Cardiol. 2021 Sep;78(3):206-212. doi: 10.1016/j.jjcc.2021.02.008. Epub 2021 Mar 4.
Elevation of high-sensitivity troponin-T (hs-TnT) is linked to cardiovascular morbidity and mortality. However, its prognostic value for survival and cardiovascular events and its relation to clinical characteristics and cardiac function parameters in clinically asymptomatic adults with congenital heart disease (ACHD) needs further exploration.
A systematic literature search was performed in PubMed and Cochrane from 2010 to May 2020 for hs-TnT as a prognostic marker in ACHD. Three independent reviewers evaluated the articles according to the Study Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies of the National Heart, Lung, and Blood Institute. Overall, eight studies with a total of 2162 ACHD patients (18-63 years) were included.
Hs-TnT level was elevated in 8-26% of asymptomatic ACHD. The follow-up for all-cause mortality and cardiovascular events ranged from 3.0 to 5.6 years and in 8-38% of the participants cardiac endpoints were reached. Throughout the included studies, elevated hs-TnT was found to be an independent predictor for survival and heart failure in stable ACHD. Serial hs-TnT measurement was found to be beneficial over single measurement. Hs-TnT levels were correlated with male sex, higher age, and higher New York Heart Association class and associated with several cardiac dysfunction parameters.
More scientific research investigating the prognostic value of hs-TnT in stable ACHD is needed and the clinical relevance to guide aftercare has still to be determined.
高敏肌钙蛋白 T（hs-TnT）升高与心血管发病率和死亡率相关。然而，其在临床无症状的先天性心脏病（ACHD）患者中的生存和心血管事件预后价值及其与临床特征和心功能参数的关系仍需进一步探讨。
从 2010 年至 2020 年 5 月，我们在 PubMed 和 Cochrane 中进行了系统的文献检索，以 hs-TnT 作为 ACHD 的预后标志物。三位独立的审稿人根据美国国立心肺血液研究所的观察性队列和横断面研究的研究质量评估工具对文章进行了评估。共有八项研究，共纳入 2162 例 ACHD 患者（18-63 岁）。
无症状 ACHD 中 8-26%的患者 hs-TnT 水平升高。所有原因死亡率和心血管事件的随访时间为 3.0 至 5.6 年，8-38%的参与者达到了心脏终点。在纳入的研究中，hs-TnT 升高被发现是稳定 ACHD 患者生存和心力衰竭的独立预测因子。与单次测量相比，连续测量 hs-TnT 更有益。hs-TnT 水平与男性、较高的年龄和较高的纽约心脏协会（NYHA）分级相关，并且与多个心功能障碍参数相关。
需要进一步开展研究，以探讨 hs-TnT 在稳定 ACHD 中的预后价值，以及其对指导后续护理的临床相关性仍有待确定。
