Yildirim Mustafa, Reich Christoph, Salbach Christian, Pribe-Wolferts Regina, Milles Barbara Ruth, Täger Tobias, Mueller-Hennessen Matthias, Weiler Markus, Meder Benjamin, Frey Norbert, Giannitsis Evangelos
Department of Internal Medicine III, Cardiology, University Hospital of Heidelberg, Heidelberg, Germany.
Institute for Cardiomyopathies & Center for Cardiogenetics, Department of Medicine III, Heidelberg University, Heidelberg, Germany.
ESC Heart Fail. 2024 Dec;11(6):3732-3741. doi: 10.1002/ehf2.14864. Epub 2024 Jul 11.
Concentrations of high-sensitivity cardiac troponin T (hs-cTnT) are frequently elevated in stable patients with confirmed muscle dystrophies. However, sparse information is available on the interpretation of serial concentration changes.
Hs-cTnT was collected in 35 stable outpatients with confirmed skeletal muscle dystrophies at 0 and 1 h and after 6-12 months during scheduled outpatient visits. We simulated the effectiveness of the European Society of Cardiology (ESC) 0/1 h algorithm and assessed biological variation at 6-12 months using two established methods: reference change value (RCV) and minimal important difference (MID).
Median baseline hs-cTnT concentrations were 34.4 ng/L [inter-quartile range (IQR): 17.5-46.2], and values > 99th percentile upper limit of normal were present in 34 of 35 patients. All patients were stable without cardiovascular adverse events during a follow-up of 6.6 months (IQR: 6-7). Median concentration change was 1.9 ng/L (IQR: 0.7-3.2) and 0.8 ng/L (IQR: 0-7.0) at 60 min and 6-9 months, respectively. Applying the criteria of the ESC 0/1 h algorithm for triage of suspected acute coronary syndrome (ACS) showed poor overall effectiveness of baseline hs-cTnT values. No patient would qualify for rule-out based on hs-cTnT less than the limit of detection, whereas five cases would qualify for rule-in based on hs-cTnT ≥ 52 ng/L. Biological variabilities at 6-12 months per MID and RCV were 1.2 ng/L [95% confidence interval (CI): 0.7-2.1] and 28.6% (95% CI: 27.9-29.6), respectively. A total of 8 (22.9%) and 25 (71.4%) cases exceeded the biological variation range, suggesting some additional myocardial damage.
The high prevalence of elevated hs-cTnT could negatively impact the effectiveness of rule-out and rule-in strategies based on a single hs-cTnT value. Knowledge of the physiological and biological variation of hs-cTnT after 6-12 months is helpful to detect the progression of cardiac involvement or to search for cardiac complications including but not limited to arrhythmias that may trigger acute or chronic myocardial damage.
在确诊为肌肉萎缩症的稳定患者中，高敏心肌肌钙蛋白T（hs-cTnT）浓度常常升高。然而，关于系列浓度变化解读的信息却很稀少。
在定期门诊就诊时，收集了35例确诊为骨骼肌萎缩症的稳定门诊患者在0小时、1小时以及6 - 12个月后的hs-cTnT。我们模拟了欧洲心脏病学会（ESC）0/1小时算法的有效性，并使用两种既定方法评估了6 - 12个月时的生物学变异：参考变化值（RCV）和最小重要差异（MID）。
hs-cTnT的基线中位数浓度为34.4 ng/L [四分位间距（IQR）：17.5 - 46.2]，35例患者中有34例的值高于正常上限的第99百分位数。在6.6个月（IQR：6 - 7）的随访期间，所有患者均稳定，无心血管不良事件。60分钟和6 - 9个月时的浓度变化中位数分别为1.9 ng/L（IQR：0.7 - 3.2）和0.8 ng/L（IQR：0 - 7.0）。应用ESC 0/1小时算法对疑似急性冠状动脉综合征（ACS）进行分诊的标准显示，基线hs-cTnT值的总体有效性较差。没有患者会因hs-cTnT低于检测限而符合排除标准，而有5例患者会因hs-cTnT≥52 ng/L而符合纳入标准。根据MID和RCV计算的6 - 12个月时的生物学变异分别为1.2 ng/L [95%置信区间（CI）：0.7 - 2.1]和28.6%（95% CI：27.9 - 29.6）。共有8例（22.9%）和25例（71.4%）病例超过了生物学变异范围，提示存在一些额外的心肌损伤。
hs-cTnT升高的高患病率可能会对基于单个hs-cTnT值的排除和纳入策略的有效性产生负面影响。了解6 - 12个月后hs-cTnT的生理和生物学变异，有助于检测心脏受累的进展或寻找包括但不限于可能引发急性或慢性心肌损伤的心律失常在内的心脏并发症。
