Association of troponin T detected with a highly sensitive assay and cardiac structure and mortality risk in the general population.
Association of troponin T detected with a highly sensitive assay and cardiac structure and mortality risk in the general population.
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DOI：
10.1001/jama.2010.1768
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发表时间：
2010-12-08
期刊：
影响因子：
--
通讯作者：
McGuire DK
中科院分区：
文献类型：
--
作者：
de Lemos JA;Drazner MH;Omland T;Ayers CR;Khera A;Rohatgi A;Hashim I;Berry JD;Das SR;Morrow DA;McGuire DK
心肌肌钙蛋白T（cTnT）的可检测水平与结构性心脏病以及死亡和不良心血管事件风险增加密切相关;然而，使用标准检测方法在一般人群中很少检测到cTnT。使用一种新的高灵敏度检测方法确定人群中可检测cTnT的患病率和决定因素，并评估使用新检测方法测量的cTnT水平是否与病理性心脏表型和随后的死亡率相关。在2000年至2002年参加达拉斯心脏研究（一项多种族、基于人群的队列研究）的3546名年龄在30至65岁之间的个体中，使用标准和高灵敏度测定法测量心肌肌钙蛋白T水平。死亡率随访一直持续到2007年。根据cTnT水平将参与者分为5类。通过中位6.4年（四分位距，6.0-6.8）的随访，对心脏结构和功能以及死亡率进行磁共振成像测量。在达拉斯县，高灵敏度检测试剂盒可检出cTnT（≥0.003 ng/mL）的患病率为25.0%（95%置信区间[CI]，22.7%-27.4%），标准检测试剂盒为0.7%（95% CI，0.3%-1.1%）。男性患病率为37.1%（95% CI，33.3%-41.0%），女性为12.9%（95% CI，10.6%-15.2%），40岁以下受试者为14.0%（95% CI，11.2%-16.9%），60岁及以上受试者为57.6%（95% CI，47.0%-68.2%）。左心室肥厚的患病率从7.5%（95% CI，6.4%-8.8%）在最低cTnT类别中（<0.003 ng/mL）至48.1%（95% CI，36.7%-59.6%）（≥0.014 ng/mL）（P < .001）;左心室收缩功能障碍和慢性肾脏疾病的患病率也在各类别中增加（P < .001）。在中位随访6.4年期间，共有151例死亡，其中包括62例心血管疾病死亡。在cTnT较高的类别中，全因死亡率从1.9%（95% CI，1.5%-2.6%）增加到28.4%（95% CI，21.0%-37.8%）（P < .001）。在校正传统风险因素、C反应蛋白水平、慢性肾脏疾病和N末端脑型利钠肽前体水平后，cTnT类别仍与全因死亡率独立相关（最高类别中校正风险比为2.8 [95%CI，1.4-5.2]）。将cTnT类别添加到完全校正的死亡率模型中适度改善了模型拟合（P = .02）和综合区分指数（0.010 [95% CI，0.002-0.018]; P = .01）。在这个基于人群的队列中，用高灵敏度检测方法检测到的cTnT与结构性心脏病和随后的全因死亡风险相关。
Detectable levels of cardiac troponin T (cTnT) are strongly associated with structural heart disease and increased risk of death and adverse cardiovascular events; however, cTnT is rarely detectable in the general population using standard assays. To determine the prevalence and determinants of detectable cTnT in the population using a new highly sensitive assay and to assess whether cTnT levels measured with the new assay associate with pathological cardiac phenotypes and subsequent mortality. Cardiac troponin T levels were measured using both the standard and the highly sensitive assays in 3546 individuals aged 30 to 65 years enrolled between 2000 and 2002 in the Dallas Heart Study, a multiethnic, population-based cohort study. Mortality follow-up was complete through 2007. Participants were placed into 5 categories based on cTnT levels. Magnetic resonance imaging measurements of cardiac structure and function and mortality through a median of 6.4 (interquartile range, 6.0–6.8) years of follow-up. In Dallas County, the prevalence of detectable cTnT (≥0.003 ng/mL) was 25.0% (95% confidence interval [CI], 22.7%−27.4%) with the highly sensitive assay vs 0.7% (95% CI, 0.3%−1.1%) with the standard assay. Prevalence was 37.1% (95% CI, 33.3%−41.0%) in men vs 12.9% (95%CI,10.6%−15.2%) in women and 14.0% (95% CI, 11.2%−16.9%) in participants younger than 40 years vs 57.6% (95% CI,47.0%−68.2%) in those 60 years and older. Prevalence of left ventricular hypertrophy increased from 7.5% (95% CI, 6.4%−8.8%) in the lowest cTnT category (<0.003 ng/mL) to 48.1% (95% CI, 36.7%−59.6%) in the highest (≥0.014 ng/mL) (P < .001); prevalence of left ventricular systolic dysfunction and chronic kidney disease also increased across categories (P < .001 for each). During a median follow-up of 6.4 years, there were 151 total deaths, including 62 cardiovascular disease deaths. All-cause mortality increased from 1.9% (95% CI, 1.5%−2.6%) to 28.4% (95% CI, 21.0%−37.8%) across higher cTnT categories (P < .001). After adjustment for traditional risk factors, C-reactive protein level, chronic kidney disease, and N-terminal pro-brain-type natriuretic peptide level, cTnT category remained independently associated with all-cause mortality (adjusted hazard ratio, 2.8 [95% CI, 1.4–5.2] in the highest category). Adding cTnT categories to the fully adjusted mortality model modestly improved model fit (P = .02) and the integrated discrimination index (0.010 [95% CI, 0.002–0.018]; P = .01). In this population-based cohort, cTnT detected with a highly sensitive assay was associated with structural heart disease and subsequent risk for all-cause mortality.
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