Chattranukulchai Pairoj, Vassara Manasawee, Siwamogsatham Sarawut, Buddhari Wacin, Tumkosit Monravee, Ketloy Chutitorn, Shantavasinkul Prapimporn, Apornpong Tanakorn, Lwin Hay Mar Su, Kerr Stephen J, Boonyaratavej Smonporn, Avihingsanon Anchalee
Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, and Cardiac Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Division of Hospital and Ambulatory Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, and Cardiac Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Open Forum Infect Dis. 2023 May 3;10(7):ofad234. doi: 10.1093/ofid/ofad234. eCollection 2023 Jul.
Elevated levels of high-sensitivity cardiac troponin (hs-cTn) are suggestive of myocardial cell injury and coronary artery disease. We explored the association between hs-cTn and subclinical arteriosclerosis using coronary artery calcification (CAC) scoring among 337 virally suppressed patients with human immunodeficiency virus (HIV) who were ≥50 years old and without evidence of known coronary artery disease.
Noncontrast cardiac computed tomography and blood sampling for hs-cTn, both subunit I (hs-cTnI) and subunit T (hs-cTnT), were performed. The relationship between CAC (Agatston score) and serum hs-cTn levels was analyzed using Spearman correlation and logistic regression models.
The patients, of whom 62% were male, had a median age of 54 years and had been on antiretroviral therapy for a median of 16 years; the CAC score was >0 in 50% of patients and ≥100 in 16%. Both hs-cTn concentrations were positively correlated with the Agatston score, with correlation coefficients of 0.28 and 0.27 ( < .001) for hs-cTnI and hs-cTnT, respectively. hs-cTnI and hs-cTnT concentrations of ≥4 and ≥5.3 pg/mL, respectively, provided the best performance for discriminating patients with Agatston scores ≥100, with a sensitivity and specificity of 76% and 60%, respectively, for hs-cTnI and 70% and 50% for hs-cTnT. In multivariable logistic regression analysis, each log unit increase in hs-cTnI level was independently associated with increased odds of having an Agatston score ≥100 (odds ratio, 2.83 [95% confidence interval, 1.69-4.75]; <.001). Although not an independent predictor, hs-cTnT was also associated with an increased odds of having an Agatston score ≥100 (odds ratio, 1.58 [95% confidence interval, .92-2.73]; = .10).
Among Asians aged ≥50 years with well-controlled HIV infection and without established cardiovascular disease, 50% had subclinical arteriosclerosis. Increasing hs-cTnI and hs-cTnT concentrations were associated with an increased risk of severe subclinical arteriosclerosis, and hs-cTn may be a potential biomarker to detect severe subclinical arteriosclerosis.
高敏心肌肌钙蛋白（hs-cTn）水平升高提示心肌细胞损伤和冠状动脉疾病。我们在337例年龄≥50岁、病毒得到抑制且无已知冠状动脉疾病证据的人类免疫缺陷病毒（HIV）感染者中，利用冠状动脉钙化（CAC）评分探讨了hs-cTn与亚临床动脉硬化之间的关联。
进行了非增强心脏计算机断层扫描以及hs-cTn亚基I（hs-cTnI）和亚基T（hs-cTnT）的血液采样。使用Spearman相关性分析和逻辑回归模型分析了CAC（阿加斯顿评分）与血清hs-cTn水平之间的关系。
患者中62%为男性，中位年龄为54岁，接受抗逆转录病毒治疗的中位时间为16年；50%的患者CAC评分>0，16%的患者≥100。两种hs-cTn浓度均与阿加斯顿评分呈正相关，hs-cTnI和hs-cTnT的相关系数分别为0.28和0.27（P<0.001）。hs-cTnI浓度≥4 pg/mL和hs-cTnT浓度≥5.3 pg/mL分别对鉴别阿加斯顿评分≥100的患者表现最佳，hs-cTnI的敏感性和特异性分别为76%和60%，hs-cTnT的敏感性和特异性分别为70%和50%。在多变量逻辑回归分析中，hs-cTnI水平每增加一个对数单位与阿加斯顿评分≥100的几率增加独立相关（比值比，2.83[95%置信区间，1.69 - 4.75]；P<0.001）。虽然hs-cTnT不是独立预测因子，但也与阿加斯顿评分≥100的几率增加相关（比值比，1.58[95%置信区间，0.92 - 2.73]；P = 0.10）。
在年龄≥50岁、HIV感染得到良好控制且无已确诊心血管疾病的亚洲人中，50%有亚临床动脉硬化。hs-cTnI和hs-cTnT浓度升高与严重亚临床动脉硬化风险增加相关，hs-cTn可能是检测严重亚临床动脉硬化的潜在生物标志物。
