Usefulness of Released Cardiac Myosin Binding Protein-C as a Predictor of Cardiovascular Events.
Usefulness of Released Cardiac Myosin Binding Protein-C as a Predictor of Cardiovascular Events.
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DOI：
10.1016/j.amjcard.2017.07.042
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发表时间：
2017-11-01
期刊：
影响因子：
--
通讯作者：
Sadayappan S
中科院分区：
文献类型：
--
作者：
Tong CW;Dusio GF;Govindan S;Johnson DW;Kidwell DT;De La Rosa LM;Rosas PC;Liu Y;Ebert E;Newell-Rogers MK;Michel JB;Trzeciakowski JP;Sadayappan S
心肌肌球蛋白结合蛋白-C (cMyBP-C) 是一种心肌特异性粗丝蛋白。血清 cMyBP-C 水平升高是早期心肌梗死 (MI) 的指标，但其作为未来心血管疾病预测因子的价值尚不清楚。基于先前研究对象的血清中存在与 MI 无关的大量 cMyBP-C，我们假设循环 cMyBP-C 是持续心血管应激和疾病的敏感指标。为了检验这一假设，招募了 75 名年龄相近的男性和 83 名女性进行前瞻性研究。他们接受了运动负荷超声心动图检查，以提供负荷前和负荷后的血液样本，用于随后测定血清 cMyBP-C 水平。对受试者进行了 1 至 1.5 年的随访。运动应激增加了所有受试者的血清 cMyBP-C。发生了 27 例主要事件（例如死亡、心肌梗死、血运重建、侵入性心血管手术或心血管相关住院治疗）和 7 例关键事件（CE；例如死亡、心肌梗死、中风或肺栓塞）。使用多变量 Cox 回归调整性别和心血管危险因素后，96% 敏感的预应力 cMyBP-C 阈值的主要事件风险比为 8.1，p = 0.041。大多数患有 CE 的受试者（7 名中的 6 名）在超声心动图上显示射血分数正常。预应力 cMyBP-C 显示 CE 的受试者工作曲线下面积为 0.91，多变量 Cox 回归风险比为 13.8 (p = 0.000472)。因此，基础cMyBP-C水平反映了对多种心血管疾病的易感性。加上其高灵敏度，cMyBP-C 具有作为严重心血管疾病筛查生物标志物的潜力。
Cardiac myosin binding protein-C (cMyBP-C) is a heart muscle-specific thick filament protein. Elevated level of serum cMyBP-C is an indicator of early myocardial infarction (MI), but its value as a predictor of future cardiovascular disease is unknown. Based on the presence of significant amount of cMyBP-C in the serum of previous study subjects independent of MI, we hypothesized that circulating cMyBP-C is a sensitive indicator of ongoing cardiovascular stress and disease. To test this hypothesis, 75 men and 83 women of similar ages were recruited for a prospective study. They underwent exercise stress echocardiography to provide pre- and poststress blood samples for subsequent determination of serum cMyBP-C levels. The subjects were followed for 1 to 1.5 years. Exercise stress increased serum cMyBP-C in all subjects. Twenty-seven primary events (such as death, MI, revascularization, invasive cardiovascular procedure, or cardiovascular-related hospitalization) and 7 critical events (CE; such as death, MI, stroke, or pulmonary embolism) occurred. After adjusting for sex and cardiovascular risk factors with multivariate Cox regression, a 96% sensitive prestress cMyBP-C threshold carried a hazard ratio of 8.1 with p = 0.041 for primary events. Most subjects (6 of 7) who had CE showed normal ejection fraction on echocardiography. Pre-stress cMyBP-C demonstrated area under receiver operating curve of 0.91 and multivariate Cox regression hazard ratio of 13.8 (p = 0.000472) for CE. Thus, basal cMyBP-C levels reflected susceptibility for a variety of cardiovascular diseases. Together with its high sensitivity, cMyBP-C holds potential as a screening biomarker for the existence of severe cardiovascular diseases.
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