高敏肌钙蛋白I对非ST段抬高型心肌梗死患者左心室射血分数的预测价值

Predictive Value of High-Sensitivity Troponin I for Left Ventricular Ejection Fraction in Patients with Non-ST-Elevation Myocardial Infarction.

作者信息

Hai Tran Nguyen Phuong, Kha Nguyen Minh, Dat Do Nguyen Tuong, Tai Nguyen Nhat, Hung Truong Phi, Sy Hoang Van

机构信息

Department of Interventional Cardiology, Cho Ray Hospital, Ho Chi Minh City, Vietnam.

Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.

出版信息

Acta Inform Med. 2025;33(1):40-46. doi: 10.5455/aim.2024.33.40-46.

DOI:10.5455/aim.2024.33.40-46

PMID:40223856

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11986349/

Abstract

BACKGROUND

According to the World Health Organization's 2021 statistics, cardiovascular diseases (CVDs), particularly coronary artery disease (CAD), remain among the leading causes of global morbidity and mortality, affecting both high-income and low-income countries like Vietnam.

OBJECTIVE

Acute myocardial infarction (AMI) remains a major cause of mortality and cardiovascular complications, with a poor prognosis in patients with left ventricular systolic dysfunction (LVSD). High-sensitivity cardiac troponin I (hs-cTnI) is a specific biomarker of myocardial injury linked to infarct size and LVSD. However, its role in predicting left ventricular ejection fraction (LVEF) in non-ST-elevation myocardial infarction (NSTEMI) is underexplored. This study investigates the correlation between hs-cTnI and LVSD in NSTEMI patients.

METHODS

A descriptive, cross-sectional study was conducted on 117 patients with first-time NSTEMI treated at Cho Ray Hospital from February 2024 to April 2024. Admission hs-cTnI levels were measured and correlated with LVEF, assessed via echocardiography. The predictive value and optimal cut-off points of hs-cTnI for LVSD (LVEF < 50% and ≤ 40%) were determined using receiver operating characteristic (ROC) curve analysis.

RESULTS

Hs-cTnI levels showed a significant inverse correlation with LVEF (r = - 0.569, p < 0.001). Patients with moderate-to-severe LVSD (LVEF ≤ 40%) had the highest median hs-cTnI levels (25,000 pg/mL, p < 0.001). The area under the ROC curve (AUC) for predicting LVEF < 50% was 0.78, with a cut-off of 12,344 pg/mL (sensitivity 68.5%, specificity 82.5%). For LVEF ≤ 40%, the AUC was 0.82, with a cut-off of 20,979 pg/mL (sensitivity 73.3%, specificity 88.5%, accuracy 84.6%). These findings underscore hs-cTnI's utility in identifying LVSD.

CONCLUSION

Hs-cTnI is inversely correlated with LVEF and serves as a reliable biomarker for predicting LVSD in NSTEMI patients, facilitating risk stratification and early management decisions.

摘要

背景

根据世界卫生组织2021年的统计数据，心血管疾病（CVD），尤其是冠状动脉疾病（CAD），仍然是全球发病和死亡的主要原因之一，影响着越南等高收入和低收入国家。

目的

急性心肌梗死（AMI）仍然是死亡和心血管并发症的主要原因，左心室收缩功能障碍（LVSD）患者的预后较差。高敏心肌肌钙蛋白I（hs-cTnI）是一种与梗死面积和LVSD相关的心肌损伤特异性生物标志物。然而，其在预测非ST段抬高型心肌梗死（NSTEMI）患者左心室射血分数（LVEF）方面的作用尚未得到充分研究。本研究调查了NSTEMI患者hs-cTnI与LVSD之间的相关性。

方法

对2024年2月至2024年4月在胡志明市肿瘤医院接受治疗的117例首次发生NSTEMI的患者进行了一项描述性横断面研究。测量入院时的hs-cTnI水平，并将其与通过超声心动图评估的LVEF进行相关性分析。使用受试者工作特征（ROC）曲线分析确定hs-cTnI对LVSD（LVEF<50%和≤40%）的预测价值和最佳截断点。

结果

Hs-cTnI水平与LVEF呈显著负相关（r=-0.569，p<0.001）。中重度LVSD（LVEF≤40%）患者的hs-cTnI中位数水平最高（25,000 pg/mL，p<0.001）。预测LVEF<50%的ROC曲线下面积（AUC）为0.78，截断值为12,344 pg/mL（敏感性68.5%，特异性82.5%）。对于LVEF≤40%，AUC为0.82，截断值为20,979 pg/mL（敏感性73.3%，特异性88.5%，准确性84.6%）。这些发现强调了hs-cTnI在识别LVSD方面的实用性。