Serial measurement of hFABP and high-sensitivity troponin I post-PCI in STEMI: how fast and accurate can myocardial infarct size and no-reflow be predicted?
Serial measurement of hFABP and high-sensitivity troponin I post-PCI in STEMI: how fast and accurate can myocardial infarct size and no-reflow be predicted?
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DOI：
10.1152/ajpheart.00447.2013
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发表时间：
2013-10-01
影响因子：
4.8
通讯作者：
van Beusekom, Heleen M. M.
中科院分区：
文献类型：
--
作者：
Uitterdijk, Andre;Sneep, Stefan;van Beusekom, Heleen M. M.
本研究的目的是通过连续测量比较心脏特异性脂肪酸结合蛋白（hFABP）和高敏肌钙蛋白I（hsTnI），以确定早期时间点，从而准确定量ST段抬高型心肌梗死（STEMI）临床前猪模型的梗死面积和无复流。心肌坏死，通常由hsTnI或TnT证实，在没有再灌注的情况下，在血浆水平升高之前需要几个小时的缺血。我们评价了快速标记物hFABP与hsTnI的比较，以估计猪STEMI再灌注（2小时闭塞）和非再灌注（8小时闭塞）后的梗死面积和无复流。在猪中诱导的STEMI（n = 4）和STEMI +再灌注（n = 8）中，取系列血液样品用于hFABP和hsTnI，并与三苯基四氮唑氯化物和硫磺素-S染色进行比较，用于在安乐死时的梗死面积和无复流。hFABP在阻断后比hsTnI增加更快（82 +/- 29 vs.180 +/- 73 min，P < 0.05），并在再灌注后立即增加，而hsTnI释放延迟16 +/- 3 min（P < 0.05）。hFABP和hsTnI再灌注峰值分别在30 +/-5和139 +/-21 min达到（P < 0.05）。心脏大小（包含84 ± 0.6%无复流）与hFABP曲线下面积相关性良好（r（2）= 0.92），但与hsTnI相关性较低（r（2）= 0.53）。在再灌注50和60分钟时，hFABP与梗死面积（r（2）= 0.94和0.93）和无复流（r（2）= 0.96和0.94）相关性最好，并显示出对心肌坏死的高敏感性（2.3 +/- 0.6和0.4 +/- 0.6 g）。在再灌注后早期测量时，在STEMI +再灌注组中，hFABP比hsTnI升高更快，与梗死面积和无复流相关性更好。检测心肌坏死的最高灵敏度为再灌注后60分钟的0.4 +/- 0.6 g，提供了梗死面积和无复流的准确和早期测量。
The objective of this study was to compare heart-specific fatty acid binding protein (hFABP) and high-sensitivity troponin I (hsTnI) via serial measurements to identify early time points to accurately quantify infarct size and no-reflow in a preclinical swine model of ST-elevated myocardial infarction (STEMI). Myocardial necrosis, usually confirmed by hsTnI or TnT, takes several hours of ischemia before plasma levels rise in the absence of reperfusion. We evaluated the fast marker hFABP compared with hsTnI to estimate infarct size and no-reflow upon reperfused (2 h occlusion) and nonreperfused (8 h occlusion) STEMI in swine. In STEMI (n = 4) and STEMI + reperfusion (n = 8) induced in swine, serial blood samples were taken for hFABP and hsTnI and compared with triphenyl tetrazolium chloride and thioflavin-S staining for infarct size and no-reflow at the time of euthanasia. hFABP increased faster than hsTnI upon occlusion (82 +/- 29 vs. 180 +/- 73 min, P < 0.05) and increased immediately upon reperfusion while hsTnI release was delayed 16 +/- 3 min (P < 0.05). Peak hFABP and hsTnI reperfusion values were reached at 30 +/- 5 and 139 +/- 21 min, respectively (P < 0.05). Infarct size (containing 84 +/- 0.6% no-reflow) correlated well with area under the curve for hFABP (r(2) = 0.92) but less for hsTnI (r(2) = 0.53). At 50 and 60 min reperfusion, hFABP correlated best with infarct size (r(2) = 0.94 and 0.93) and no-reflow (r(2) = 0.96 and 0.94) and showed high sensitivity for myocardial necrosis (2.3 +/- 0.6 and 0.4 +/- 0.6 g). hFABP rises faster and correlates better with infarct size and no-reflow than hsTnI in STEMI + reperfusion when measured early after reperfusion. The highest sensitivity detecting myocardial necrosis, 0.4 +/- 0.6 g at 60 min postreperfusion, provides an accurate and early measurement of infarct size and no-reflow.