Topf Albert, Mirna Moritz, Bacher Nina, Paar Vera, Edlinger Christoph, Motloch Lukas J, Gharibeh Sarah, Bannehr Marwin, Hoppe Uta C, Lichtenauer Michael
Department of Internal Medicine II, Paracelsus Medical University, 5020 Salzburg, Austria.
Department of Cardiology, Heart Center Brandenburg, 16321 Bernau bei Berlin, Germany.
J Cardiovasc Dev Dis. 2021 Oct 5;8(10):127. doi: 10.3390/jcdd8100127.
Takotsubo cardiomyopathy (TTC) remains a life-threatening disease with the risk of decompensated heart failure and arrhythmias. Valid markers for the prediction of outcome are unavailable. The novel biomarkers fetuin-A, matrix metalloproteinases-2 (MMP-2), myeloperoxidase (MPO), Syndecan-1 and CD40-L show promising results for risk stratification of cardiovascular patients. Nevertheless, clinical implementation has not been investigated in TTC patients.
To investigate this issue, we evaluated clinical complications in 51 patients hospitalized for TTC and measured the serum levels of fetuin-A, MPO, MMP-2, Syndecan-1 and CD40-L within 24 h after admission.
Serum levels of Fetuin-A correlated inversely with the risk of cardiac decompensation and all cause complications within the acute phase of TTC. Fetuin-A levels over 190.1 µg/mL (AUC: 0.738, sensitivity 87.5%, specificity: 52.6%) indicate an acute phase of TTC without cardiac decompensation. Despite lower fetuin-A levels in patients with all cause complications, the combined endpoint remained slightly unmet ( = 0.058, AUC: 0.655). Patients with fetuin-A levels over 213.3 µg/mL are at risk of experiencing hemodynamic relevant rhythm disorders (AUC: 0.794; sensitivity: 75.0%, specificity: 79.1%). Other biomarkers failed to reveal a prognostic impact. Pro-BNP and hs troponin levels at admission did not predict adverse cardiac events.
Fetuin-A is a promising marker in our study and could be of benefit for the prediction of short-term adverse cardiac events in TTC patients. Therefore, fetuin-A might be of value to evaluate an individual's risk for complications within the acute phase of TTC and to individually choose the time of intensive care and hospitalization.
应激性心肌病（TTC）仍然是一种危及生命的疾病，存在失代偿性心力衰竭和心律失常的风险。目前尚无有效的预测预后的标志物。新型生物标志物胎球蛋白-A、基质金属蛋白酶-2（MMP-2）、髓过氧化物酶（MPO）、Syndecan-1和CD40-L在心血管疾病患者的风险分层方面显示出有前景的结果。然而，尚未在TTC患者中研究其临床应用。
为研究此问题，我们评估了51例因TTC住院患者的临床并发症，并在入院后24小时内测量了胎球蛋白-A、MPO、MMP-2、Syndecan-1和CD40-L的血清水平。
在TTC急性期，胎球蛋白-A的血清水平与心脏失代偿风险及所有原因导致的并发症呈负相关。胎球蛋白-A水平超过190.1μg/mL（曲线下面积：0.738，敏感性87.5%，特异性：52.6%）表明TTC急性期无心脏失代偿。尽管所有原因导致并发症的患者胎球蛋白-A水平较低，但联合终点仍未完全达到（P = 0.058，曲线下面积：0.655）。胎球蛋白-A水平超过213.3μg/mL的患者有发生血流动力学相关心律失常的风险（曲线下面积：0.794；敏感性：75.0%，特异性：79.1%）。其他生物标志物未显示出预后影响。入院时的脑钠肽前体（Pro-BNP）和高敏肌钙蛋白水平不能预测不良心脏事件。
在我们的研究中，胎球蛋白-A是一个有前景的标志物，可能有助于预测TTC患者的短期不良心脏事件。因此，胎球蛋白-A可能对于评估TTC急性期个体的并发症风险以及个体化选择重症监护和住院时间具有价值。
