High-sensitivity troponin I concentrations are a marker of an advanced hypertrophic response and adverse outcomes in patients with aortic stenosis
High-sensitivity troponin I concentrations are a marker of an advanced hypertrophic response and adverse outcomes in patients with aortic stenosis
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DOI：
10.1093/eurheartj/ehu189
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发表时间：
2014-09-07
影响因子：
39.3
通讯作者：
Dweck, Marc R.
中科院分区：
文献类型：
--
作者：
Chin, Calvin W. L.;Shah, Anoop S. V.;Dweck, Marc R.
目的高灵敏度心肌肌钙蛋白I（cTnI）检测有望检测主动脉瓣狭窄从肥厚到心力衰竭的转变。我们试图探讨肌钙蛋白释放的机制与主动脉瓣狭窄患者和血浆cTnI浓度是否与长期outcome.Methods和结果血浆cTnI浓度测定在两个患者队列使用高灵敏度分析。首先，在机制队列中，122例主动脉瓣狭窄患者（中位年龄71岁，67%为男性，主动脉瓣面积1.0 +/- 0.4 cm（2））接受了心血管磁共振和超声心动图检查，以评估左心室（LV）心肌质量、功能和纤维化。左室质量指数和替代纤维化指标（晚期钆增强）与cTnI浓度相关，与年龄、性别、冠状动脉疾病、主动脉瓣狭窄严重程度和舒张功能无关。在单独的结局队列中，最初招募到苏格兰主动脉瓣狭窄和降脂试验，消退影响（SALTIRE）研究的131例患者对主动脉瓣置换术（AVR）和心血管死亡的发生进行了长期随访。中位随访时间为10.6年（1178患者-年），24例患者死于心血管原因，60例患者接受AVR。血浆cTnI浓度与AVR或心血管死亡HR 1.77（95%CI，1.22至2.55）独立的年龄，性别，收缩期射血分数，和主动脉瓣狭窄severity.Conclusions在主动脉瓣狭窄患者中，血浆cTnI浓度与先进的肥厚和替代心肌纤维化以及AVR或心血管死亡。
Aims High-sensitivity cardiac troponin I (cTnI) assays hold promise in detecting the transition from hypertrophy to heart failure in aortic stenosis. We sought to investigate the mechanism for troponin release in patients with aortic stenosis and whether plasma cTnI concentrations are associated with long-term outcome.Methods and results Plasma cTnI concentrations were measured in two patient cohorts using a high-sensitivity assay. First, in the Mechanism Cohort, 122 patients with aortic stenosis (median age 71, 67% male, aortic valve area 1.0 +/- 0.4 cm(2)) underwent cardiovascular magnetic resonance and echocardiography to assess left ventricular (LV) myocardial mass, function, and fibrosis. The indexed LV mass and measures of replacement fibrosis (late gadolinium enhancement) were associated with cTnI concentrations independent of age, sex, coronary artery disease, aortic stenosis severity, and diastolic function. In the separate Outcome Cohort, 131 patients originally recruited into the Scottish Aortic Stenosis and Lipid Lowering Trial, Impact of REgression (SALTIRE) study, had long-term follow-up for the occurrence of aortic valve replacement (AVR) and cardiovascular deaths. Over a median follow-up of 10.6 years (1178 patient-years), 24 patients died from a cardiovascular cause and 60 patients had an AVR. Plasma cTnI concentrations were associated with AVR or cardiovascular death HR 1.77 (95% CI, 1.22 to 2.55) independent of age, sex, systolic ejection fraction, and aortic stenosis severity.Conclusions In patients with aortic stenosis, plasma cTnI concentration is associated with advanced hypertrophy and replacement myocardial fibrosis as well as AVR or cardiovascular death.