High-sensitivity troponin T for prediction of left ventricular function and infarct size one year following ST-elevation myocardial infarction
High-sensitivity troponin T for prediction of left ventricular function and infarct size one year following ST-elevation myocardial infarction
复制标题
DOI：
10.1016/j.ijcard.2015.09.001
复制
发表时间：
2016-01-01
影响因子：
3.5
通讯作者：
Metzler, Bernhard
中科院分区：
文献类型：
--
作者：
Reinstadler, Sebastian Johannes;Feistritzer, Hans-Josef;Metzler, Bernhard
背景：在ST段抬高型心肌梗死(STEMI)患者中，高敏心肌肌钙蛋白T(hs-cTnT)与长期心肌功能和心肌梗死范围相关的数据缺乏。我们旨在评价早期hs-cTnT浓度对STEMI后1年心脏磁共振成像(CMR)评估心肌功能和心肌梗死范围的价值。分别于入院时、术后6h、12h和2 4h测定血清hs-cTnT、肌酸激酶(CK)、超敏C反应蛋白(hs-CRP)和乳酸脱氢酶(LDH)水平。结果：除hs-cTnT入院外，所有单时点和峰值hs-cTnT浓度与基线和随访时的左心室射血分数(r=-0.404~-0.517，P<0.01)和梗塞面积(IS：R=0.421~0.700，P<0.01)均呈显著正相关。Hs-cTnT峰值曲线下面积(AUC)为0.82(95%CI为0.71~0.92)，可预测12个月后LVEF下降(8%)。四种生物标志物的联合应用预测12个月时LVEF降低和IS增大的AUC分别为0.82和0.92(PS>；0.05)。结论：在直接经皮冠状动脉介入治疗成功的STEMI患者中，hs-cTnT的系列和峰值浓度与长期的LVEF和IS密切相关。与单独使用hs-cTnT相比，hs-cTnT与CK、hs-CRP或LDH联合应用并不能增加任何显著的预后价值。(C)2015爱思唯尔爱尔兰有限公司。保留所有权利。
Background: Data relating high-sensitivity cardiac troponin T (hs-cTnT) to long-term myocardial function and infarct size in patients after ST-elevation myocardial infarction (STEMI) are lacking. We aimed to evaluate the use of early hs-cTnT concentrations for prediction of myocardial function and infarct size assessed by cardiac magnetic resonance imaging (CMR) one year following STEMI.Methods: Sixty-six patients, revascularized by primary percutaneous coronary intervention (PCI) for first-time STEMI, were enrolled in this observational study. Serial hs-cTnT, creatine kinase (CK), high-sensitivity C-reactive protein (hs-CRP) and lactate dehydrogenase (LDH) levels were measured on admission, 6 h, 12 h, and 24 h post-PCI. Patients underwent CMR within the first week and 12 months thereafter.Results: Except for admission hs-cTnT, all single time point and peak hs-cTnT concentrations showed significant correlations with left ventricular ejection fraction (LVEF: r = -0.404 to -0.517, all ps < 0.01) and infarct size (IS: r = 0.421 to 0.700, all ps < 0.01) at baseline and follow-up. The area under the curve (AUC) of peak hs-cTnT was 0.82 (95% CI 0.71-0.92) for the prediction of decreased LVEF (8%) at 12 months. The combination of all four biomarkers resulted in an AUC of 0.82 and 0.92 for the prediction of reduced LVEF and large IS at 12 months, respectively (both ps > 0.05).Conclusion: In stable STEMI patients successfully revascularized by primary PCI, serial and peak concentrations of hs-cTnT are closely correlated to long-term LVEF and IS. Combination of hs-cTnT with CK, hs-CRP, or LDH did not add any significant prognostic value as compared with hs-cTnT alone. (C) 2015 Elsevier Ireland Ltd. All rights reserved.