Myhre Peder L, Claggett Brian, Ballantyne Christie M, Hoogeveen Ron C, Selvin Elizabeth, Matsushita Kunihiro, Kitzman Dalane, Konety Suma, Mosley Thomas, Shah Amil M
Akershus University Hospital and University of Oslo, Norway (P.L.M.).
Brigham and Women's Hospital, Boston, MA (B.C.).
Circulation. 2024 Dec 3;150(23):1847-1857. doi: 10.1161/CIRCULATIONAHA.124.069735. Epub 2024 Sep 24.
Higher circulating concentrations of NT-proBNP (N-terminal pro-B-type natriuretic peptide) and high-sensitivity cardiac troponin T (hs-cTnT) and I (hs-cTnI) are associated with left ventricular remodeling and with incident heart failure. The associations of these cardiac biomarkers with changes in cardiac structure and function over time are uncharacterized.
Among 2006 participants in the ARIC prospective cohort study (Atherosclerosis Risk in Communities) who were free of overt cardiovascular disease and underwent echocardiography at study visits 5 (2011- 2013) and 7 (2018-2019), we assessed the associations of NT-proBNP, hs-cTnT, and hs-cTnI concentrations at visit 5 with changes in left ventricular structure and function between visits 5 and 7 (≈7-year change) using multivariable linear regression with the biomarkers modeled as restricted cubic splines. Models were adjusted for age, sex, race, body mass index, smoking, diabetes, hypertension, and renal function at visit 5; blood pressure and heart rate at both visits; and the baseline value of the echocardiographic parameter of interest.
Mean±SD age was 74±4 years at visit 5; 61% were women; and 23% were Black adults. Median (25th-75th percentile) concentrations at visit 5 of NT-proBNP, hs-cTnT, and hs-cTnI were 87 ng/L (50-157 ng/L), 9 ng/L (6-12 ng/L), and 2.6 ng/L (1.9-3.9 ng/L). In adjusted models, elevated baseline concentrations of NT-proBNP and hs-cTnI were significantly associated with 7-year decline in left ventricular systolic function (ejection fraction, longitudinal and circumferential strain) and worsening diastolic indices. In contrast, elevated baseline concentrations of hs-cTnT were not significantly associated with 7-year changes in cardiac structure, systolic function, or diastolic function (all >0.05).
Higher concentrations of NT-proBNP and hs-cTnI, but not hs-cTnT, were associated with greater declines in left ventricular function over ≈7 years in late life independently of traditional cardiovascular risk factors.
NT - 脑钠肽前体（N末端B型利钠肽原）、高敏心肌肌钙蛋白T（hs - cTnT）和高敏心肌肌钙蛋白I（hs - cTnI）循环浓度升高与左心室重构及新发心力衰竭相关。这些心脏生物标志物随时间与心脏结构和功能变化之间的关联尚未明确。
在社区动脉粥样硬化风险（ARIC）前瞻性队列研究的2006名参与者中，这些参与者无明显心血管疾病，且在研究第5次访视（2011 - 2013年）和第7次访视（2018 - 2019年）时接受了超声心动图检查，我们使用多变量线性回归评估第5次访视时NT - 脑钠肽前体、hs - cTnT和hs - cTnI浓度与第5次和第7次访视之间左心室结构和功能变化（约7年变化）的关联，将生物标志物建模为受限立方样条。模型针对第5次访视时的年龄、性别、种族、体重指数、吸烟、糖尿病、高血压和肾功能进行了调整；两次访视时的血压和心率；以及感兴趣的超声心动图参数的基线值。
第5次访视时平均年龄±标准差为74±4岁；61%为女性；23%为黑人成年人。第5次访视时NT - 脑钠肽前体、hs - cTnT和hs - cTnI的中位数（第25 - 75百分位数）浓度分别为87 ng/L（50 - 157 ng/L）、9 ng/L（6 - 12 ng/L）和2.6 ng/L（1.9 - 3.9 ng/L）。在调整模型中，NT - 脑钠肽前体和hs - cTnI的基线浓度升高与左心室收缩功能（射血分数、纵向和圆周应变）7年下降及舒张指标恶化显著相关。相比之下，hs - cTnT的基线浓度升高与心脏结构、收缩功能或舒张功能7年变化无显著关联（均>0.05）。
在晚年约7年时间里，较高浓度的NT - 脑钠肽前体和hs - cTnI，而非hs - cTnT，与左心室功能更大程度下降相关联，且独立于传统心血管危险因素。
