Taggart Caelan, Wereski Ryan, Mills Nicholas L, Chapman Andrew R
BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH16 4SA, UK.
Usher Institute, University of Edinburgh, Edinburgh EH16 4UX, UK.
J Clin Med. 2021 May 26;10(11):2331. doi: 10.3390/jcm10112331.
The application of high-sensitivity cardiac troponins in clinical practice has led to an increase in the recognition of elevated concentrations in patients without myocardial ischaemia. The Fourth Universal Definition of Myocardial Infarction encourages clinicians to classify such patients as having an acute or chronic myocardial injury based on the presence or absence of a rise or a fall in cardiac troponin concentrations. Both conditions may be caused by a variety of cardiac and non-cardiac conditions, and evidence suggests that clinical outcomes are worse than patients with myocardial infarction due to atherosclerotic plaque rupture, with as few as one-third of patients alive at 5 years. Major adverse cardiovascular events are comparable between populations, and up to three-fold higher than healthy individuals. Despite this, no evidence-based strategies exist to guide clinicians in the investigation of non-ischaemic myocardial injury. This review explores the aetiology of myocardial injury and proposes a simple framework to guide clinicians in early assessment to identify those who may benefit from further investigation and treatment for those with cardiovascular disease.
高敏心肌肌钙蛋白在临床实践中的应用使得在无心肌缺血的患者中识别出肌钙蛋白浓度升高的情况有所增加。《心肌梗死的第四次通用定义》鼓励临床医生根据心肌肌钙蛋白浓度的升高或降低情况，将此类患者归类为患有急性或慢性心肌损伤。这两种情况都可能由多种心脏和非心脏疾病引起，而且有证据表明，与因动脉粥样硬化斑块破裂导致心肌梗死的患者相比，这些患者的临床结局更差，5年时存活的患者少至三分之一。主要不良心血管事件在不同人群中相当，比健康个体高出两倍之多。尽管如此，目前尚无基于证据的策略来指导临床医生对非缺血性心肌损伤进行调查。本综述探讨了心肌损伤的病因，并提出了一个简单的框架，以指导临床医生进行早期评估，从而识别出那些可能从进一步检查中获益的患者，以及那些患有心血管疾病可能需要治疗的患者。
