Minimally elevated cardiac troponin T and elevated N-terminal pro-B-type natriuretic peptide predict mortality in older adults: results from the Rancho Bernardo Study.
Minimally elevated cardiac troponin T and elevated N-terminal pro-B-type natriuretic peptide predict mortality in older adults: results from the Rancho Bernardo Study.
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DOI：
10.1016/j.jacc.2008.04.033
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发表时间：
2008-08-05
影响因子：
24
通讯作者：
Barrett-Connor, Elizabeth
中科院分区：
文献类型：
--
作者：
Daniels, Lori B.;Laughlin, Gail A.;Clopton, Paul;Maisel, Alan S.;Barrett-Connor, Elizabeth
本研究调查了社区老年人中可检测到的心肌肌钙蛋白 T (TnT) 和 N 末端 B 型利钠肽原 (NT-proBNP) 水平升高的预后价值。在一小部分普通人群中发现 TnT（心肌细胞损伤的标志物）水平略有升高，其影响尚不确定。 NT-proBNP 是心室舒张的标志物，在许多领域都有临床用途，但其对表面健康的老年人以及与 TnT 结合的长期预后价值尚不清楚。参与者是来自 Rancho Bernardo 研究的 957 名老年人，他们在基线（1997 年至 1999 年）测量了血浆 NT-proBNP 和 TnT，并随访至 2006 年 7 月的死亡率。可检测到 TnT（≥0.01 ng/ml，n = 39）的参与者全因死亡和心血管死亡的风险增加（通过 Cox 比例风险分析调整的风险比 [HR]：2.06；95%置信区间 [CI]：1.29 至 3.28，全因死亡率 p = 0.003；HR：2.06，95% CI：1.03 至 4.12，心血管死亡率 p = 0.040）； NT-proBNP升高还预测全因死亡率和心血管死亡率的风险增加（NT-proBNP每单位对数增加调整后的HR：1.85，95％CI：1.36至2.52，全因死亡率p <0.001；HR：2.51，95％CI：1.55至4.08，心血管死亡率p <0.001）。 NT-proBNP 和可检测到的 TnT 均升高的患者生存率较差（高 NT-proBNP 和可检测到的 TnT 与低 NT-proBNP 和任何 TnT 相比，HR：3.20，95% CI：1.91 至 5.38，p < 0.001）。排除 152 名基线患有心脏病的参与者并没有实质性改变 TnT 死亡率或 NT-proBNP 死亡率关联。显然，健康成年人若可检测到 TnT 或 NT-proBNP 水平升高，死亡风险就会增加。 TnT 和 NT-proBNP 同时升高的人面临更高的风险，并且这种增加的风险会持续数年。
This study investigated the prognostic value of detectable cardiac troponin T (TnT) and elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels in a population of community-dwelling older adults. Minimally elevated levels of TnT, a marker of cardiomyocyte injury, have been found in small subsets of the general population, with uncertain implications. A marker of ventricular stretch, NT-proBNP has clinical utility in many venues, but its long-term prognostic value in apparently healthy older adults and in conjunction with TnT is unknown. Participants were 957 older adults from the Rancho Bernardo Study with plasma NT-proBNP and TnT measured at baseline (1997 to 1999) and followed up for mortality through July 2006. Participants with detectable TnT (≥0.01 ng/ml, n = 39) had an increased risk of all-cause and cardiovascular death (adjusted hazard ratio [HR] by Cox proportional hazards analysis: 2.06; 95% confidence interval [CI]: 1.29 to 3.28, p = 0.003 for all-cause mortality; HR: 2.06, 95% CI: 1.03 to 4.12, p = 0.040 for cardiovascular mortality); elevated NT-proBNP also predicted an increased risk of all-cause and cardiovascular mortality (adjusted HR per unit-log increase in NT-proBNP: 1.85, 95% CI: 1.36 to 2.52, p < 0.001 for all-cause mortality; HR: 2.51, 95% CI: 1.55 to 4.08, p < 0.001 for cardiovascular mortality). Those with both elevated NT-proBNP and detectable TnT had poorer survival (HR for high NT-proBNP and detectable TnT vs. low NT-proBNP and any TnT: 3.20, 95% CI: 1.91 to 5.38, p < 0.001). Exclusion of the 152 participants with heart disease at baseline did not materially change the TnT mortality or NT-proBNP mortality associations. Apparently healthy adults with detectable TnT or elevated NT-proBNP levels are at increased risk of death. Those with both TnT and NT-proBNP elevations are at even higher risk, and the increased risk persists for years.
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