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肌钙蛋白T评估有助于在与扩张型心肌病相关患者的年轻亲属中识别突变携带者。

Troponin T Assessment Allows for Identification of Mutation Carriers among Young Relatives of Patients with -Related Dilated Cardiomyopathy.

作者信息

Chmielewski Przemysław, Kowalik Ilona, Truszkowska Grażyna, Michalak Ewa, Ponińska Joanna, Sadowska Agnieszka, Kalin Katarzyna, Jaworski Krzysztof, Minota Ilona, Krzysztoń-Russjan Jolanta, Zieliński Tomasz, Płoski Rafał, Bilińska Zofia Teresa

机构信息

Unit for Screening Studies in Inherited Cardiovascular Diseases, National Institute of Cardiology, 04-628 Warsaw, Poland.

Clinical Research Support Centre, National Institute of Cardiology, 04-628 Warsaw, Poland.

出版信息

J Clin Med. 2024 May 28;13(11):3164. doi: 10.3390/jcm13113164.

Abstract

-related dilated cardiomyopathy (-DCM) caused by mutations in the lamin A/C gene () is one of the most common forms of hereditary DCM. Due to the high risk of mutation transmission to offspring and the high incidence of ventricular arrhythmia and sudden death even before the onset of heart failure symptoms, it is very important to identify -mutation carriers. However, many relatives of -DCM patients do not report to specialized centers for clinical or genetic screening. Therefore, an easily available tool to identify at-risk subjects is needed. We compared two cohorts of young, asymptomatic relatives of DCM patients who reported for screening: 29 mutation carriers and 43 individuals from the control group. Receiver operating characteristic (ROC) curves for potential indicators of mutation carriership status were analyzed. PR interval, N-terminal pro-B-type natriuretic peptide (NT-proBNP), and high-sensitivity cardiac troponin T (hscTnT) serum levels were higher in the mutation carrier cohort. Neither group differed significantly with regard to creatinine concentration or left ventricular ejection fraction. The best mutation carriership discriminator was hscTnT level with an optimal cut-off value at 5.5 ng/L, for which sensitivity and specificity were 86% and 93%, respectively. The median hscTnT level was 11.0 ng/L in mutation carriers vs. <3.0 ng/L in the control group, < 0.001. Wherever access to genetic testing is limited, mutation carriership status can be assessed reliably using the hscTnT assay. Among young symptomless relatives of -DCM patients, a hscTnT level >5.5 ng/L strongly suggests mutation carriers.

摘要

由核纤层蛋白A/C基因()突变引起的相关扩张型心肌病(-DCM)是遗传性DCM最常见的形式之一。由于突变传递给后代的风险很高,且即使在心力衰竭症状出现之前室性心律失常和猝死的发生率也很高,因此识别-DCM突变携带者非常重要。然而,许多-DCM患者的亲属没有到专门的中心进行临床或基因筛查。因此,需要一种易于获得的工具来识别高危人群。我们比较了两组前来进行筛查的DCM患者年轻无症状亲属:29名突变携带者和43名来自对照组的个体。分析了突变携带者状态潜在指标的受试者工作特征(ROC)曲线。突变携带者队列中的PR间期、N末端B型利钠肽原(NT-proBNP)和高敏心肌肌钙蛋白T(hscTnT)血清水平较高。两组在肌酐浓度或左心室射血分数方面无显著差异。最佳的突变携带者鉴别指标是hscTnT水平,最佳临界值为5.5 ng/L,其敏感性和特异性分别为86%和93%。突变携带者的hscTnT水平中位数为11.0 ng/L,而对照组<3.0 ng/L,<0.001。在基因检测受限的情况下,可使用hscTnT检测可靠地评估突变携带者状态。在-DCM患者的年轻无症状亲属中,hscTnT水平>5.5 ng/L强烈提示为突变携带者。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6264/11172723/6c5ab5233e16/jcm-13-03164-g001.jpg

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