Troponin T Levels and Infarct Size by SPECT Myocardial Perfusion Imaging
Troponin T Levels and Infarct Size by SPECT Myocardial Perfusion Imaging
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DOI：
10.1016/j.jcmg.2011.03.010
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发表时间：
2011-05-01
影响因子：
14
通讯作者：
Miller, Todd D.
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文献类型：
--
作者：
Arruda-Olson, Adelaide M.;Roger, Veronique L.;Miller, Todd D.
目的应用门控单光子发射型计算机断层心肌灌注显像（SPECT-MPI）评价急性心肌梗死（AMI）患者心肌肌钙蛋白T（cTnT）水平与梗死面积及左室射血分数的关系。背景目前的指南推荐使用cTnT作为诊断AMI的首选生物标志物。cTnT的SPECT-MPI在AMI患者的数据是有限的。方法一个子集的患者，他们的第一次AMI参与社区为基础的队列AMI在明尼苏达州奥姆斯特德县，进行了前瞻性研究。在疼痛发作后12小时和1天、2天和3天评估连续cTnT水平。cTnT峰值定义为cTnT最大值。结果AMI患者121例（年龄61 ± 13岁，31%为女性），在AMI后10（5，15）天的中位数（第25百分位数，75百分位数）进行门控SPECT-MPI。梗死类型为非ST段抬高型心肌梗死占61%，前壁梗死占13%。中位梗死面积为1%（0%，11%），中位门控左心室射血分数为54%（47%，60%）。59例患者（占人群的49%）通过SPECT-MPI没有可测量的梗死。可测量的SPECT-MPI梗死面积的独立预测因子包括第1、2和3天的cTnT和峰值cTnT，但不包括就诊时或< 12 h。在受试者-操作者特征分析中，曲线下面积在第3天最高。接收器操作员的特征分析表明，1.5 ng/ml的截止峰值cTnT的检测可测量的infarctsize.CONCLUSIONS在社区为基础的队列的患者与他们的第一个AMI，可测量的SPECT-MPI梗死面积的独立预测因子包括cTnT在第1，2和3天和峰值cTnT。相比之下，根据SPECT-MPI评估，就诊时和< 12 h的cTnT水平不是心肌梗死面积的独立预测因子。受试者-操作者特征分析表明，检测可测量梗死的临界值峰值cTnT为1.5 ng/ml。（J Am科尔心脏病学杂志2011;4：523-33）（C）美国心脏病学会基金会2011年
OBJECTIVES To evaluate the relationship between serial cardiac troponin T (cTnT) levels with infarct size and left ventricular ejection fraction by gated single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) in patients with acute myocardial infarction (AMI). BACKGROUND Current guidelines recommend the use of cTnT as the biomarker of choice for the diagnosis of AMI. Data relating cTnT to SPECT-MPI in patients with AMI are limited.METHODS A subset of patients with their first AMI participating in a community-based cohort of AMI in Olmsted County, Minnesota, were prospectively studied. Serial cTnT levels were evaluated at presentation, < 12 h and 1, 2, and 3 days after onset of pain. Peak cTnT was defined as the maximum cTnT value.RESULTS A total of 121 patients (age, 61 +/- 13 years; 31% women) with AMI underwent gated SPECT-MPI at a median (25th percentile, 75th percentile) of 10 (5, 15) days post-AMI. The type of infarct was non-ST-segment elevation myocardial infarction in 61%, and 13% were anterior in location. The median infarct size was 1% (0%, 11%) and the median gated left ventricular ejection fraction was 54% (47%, 60%). Fifty-nine patients (49% of the population) had no measurable infarction by SPECT-MPI. Independent predictors of measurable SPECT-MPI infarct size included cTnT at days 1, 2, and 3 and peak cTnT, but not at presentation or < 12 h. In receiver-operator characteristic analysis, the area under the curve was highest at day 3. Receiver-operator characteristic analysis demonstrated a cutoff of 1.5 ng/ml for peak cTnT for the detection of measurable infarct size.CONCLUSIONS In a community-based cohort of patients with their first AMI, independent predictors of measurable SPECT-MPI infarct size included cTnT at days 1, 2, and 3 and peak cTnT. In contrast, cTnT level at presentation and < 12 h was not an independent predictor of myocardial infarction size as assessed by SPECT-MPI. Receiver-operator characteristic analysis demonstrated a cutoff value peak cTnT of 1.5 ng/ml for the detection of measurable infarct. (J Am Coll Cardiol Img 2011;4:523-33) (C) 2011 by the American College of Cardiology Foundation