McLeod Peter, Coffey Sean, Sneddon Katherine, Williams Michael, Kerr Andrew, Pemberton James
Department of Medicine - HeartOtago, Otago Medical School, University of Otago, Dunedin, New Zealand; Department of Cardiology, Southern District Health Board, Dunedin, New Zealand.
Department of Medicine - HeartOtago, Otago Medical School, University of Otago, Dunedin, New Zealand; Department of Cardiology, Southern District Health Board, Dunedin, New Zealand.
Heart Lung Circ. 2022 Nov;31(11):1513-1523. doi: 10.1016/j.hlc.2022.07.014. Epub 2022 Aug 27.
Cardiac troponins (cTn) have been used historically to estimate infarct size in ST elevation myocardial infarction (STEMI). Within a resource constrained health care environment, cTn could therefore be used for prioritisation of patients for cardiac imaging, in particular echocardiography. We aimed to determine how useful routinely collected cTn would be in predicting significant left ventricular (LV) impairment.
All patients in the All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) registry with their first episode of STEMI between January 2013 and November 2018, who had high sensitivity troponin T measured, were included. We excluded patients with no left ventricular ejection fraction (LVEF) assessment, known LV dysfunction, or prior myocardial infarction.
In total, 3,698 patients were included in the analysis. A higher mean hsTnT (admission and peak) was seen in patients with more severely impaired LV function but there was significant overlap in the range of hsTnT between the different LVEF categories. Cardiac troponins demonstrated poor discriminative ability to either predict or exclude significant LV impairment (LVEF <40%). At an optimal cutpoint of 3,405 ng/L, peak hsTnT had a sensitivity of 56.5% (95% confidence interval [CI] 42-62%), a specificity of 65.3% (95% CI 62-79%) and an area under the receiver operating curve of 0.62 (95% CI 0.60-0.64).
This is the largest study comparing clinically measured troponin levels and LV function in patients presenting with STEMI. A definite, but weak, association was seen between peak troponin and the degree of LV dysfunction, with significant overlap in troponin levels between levels of myocardial dysfunction. Routinely acquired troponin is not suitable for clinical use as a method of prioritising patients for cardiac imaging.
心肌肌钙蛋白（cTn）一直以来被用于评估ST段抬高型心肌梗死（STEMI）的梗死面积。在资源有限的医疗环境中，cTn因此可用于对患者进行心脏成像检查（尤其是超声心动图检查）的优先级排序。我们旨在确定常规检测的cTn对预测严重左心室（LV）功能损害的有用性。
纳入2013年1月至2018年11月期间在新西兰急性冠状动脉综合征质量改进（ANZACS-QI）登记处首次发生STEMI且检测了高敏肌钙蛋白T的所有患者。我们排除了未进行左心室射血分数（LVEF）评估、已知左心室功能障碍或既往有心肌梗死的患者。
总共3698例患者纳入分析。左心室功能损害越严重的患者，其平均高敏肌钙蛋白T（入院时和峰值）越高，但不同LVEF类别之间的高敏肌钙蛋白T范围有显著重叠。心肌肌钙蛋白对预测或排除严重左心室功能损害（LVEF<40%）的鉴别能力较差。在最佳切点为3405 ng/L时，高敏肌钙蛋白T峰值的敏感性为56.5%（95%置信区间[CI] 42 - 62%），特异性为65.3%（95% CI 62 - 79%），受试者工作特征曲线下面积为0.62（95% CI 0.60 - 0.64）。
这是比较STEMI患者临床检测的肌钙蛋白水平和左心室功能的最大规模研究。在峰值肌钙蛋白与左心室功能障碍程度之间观察到明确但较弱的关联，心肌功能障碍程度不同时肌钙蛋白水平有显著重叠。常规获取的肌钙蛋白不适合作为对患者进行心脏成像检查优先级排序的临床方法。
