Improving the Primary Prevention of Cardiovascular Events by Using Biomarkers to Identify Individuals With Silent Heart Disease
Improving the Primary Prevention of Cardiovascular Events by Using Biomarkers to Identify Individuals With Silent Heart Disease
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DOI：
10.1016/j.jacc.2012.04.049
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发表时间：
2012-09-11
影响因子：
24
通讯作者：
Struthers, Allan D.
中科院分区：
文献类型：
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作者：
Nadir, M. Adnan;Rekhraj, Sushma;Struthers, Allan D.
目的 本研究的目的是检查生物标志物是否可以识别一级预防人群中的无症状心脏靶器官损伤 (cTOD)。 背景 改善心血管事件一级预防的一种可能方法是识别那些已经患有无症状 cTOD（即心肌缺血、左心室肥大、收缩功能障碍、舒张功能障碍或左心房扩大）的患者。这或许可以通过生物标志物（例如高敏心肌肌钙蛋白 T [hs-cTnT] 或 B 型利钠肽 [BNP]）筛查来实现。 方法 我们前瞻性地招募了 300 名已接受一级预防治疗的无症状个体。进行经胸超声心动图、负荷超声心动图和/或心肌灌注成像来识别无症状 cTOD。 结果 102 名 (34%) 患者有 cTOD 证据。左心室肥厚是最常见的 cTOD（29.7%），其次是舒张功能障碍（21.3%）、左心房扩大（15.3%）、收缩功能障碍（6.3%）和缺血（6.3%）。 BNP 识别任何形式的沉默 cTOD 的曲线下面积 (AUC) 总体为 0.78，男性为 0.82。女性 hs-cTnT 的等效数字为 0.70 和 0.75。男性中 BNP 和 hs-cTnT 的 AUC 合计分别为 0.81 和 0.82。然而，其他标志物的区分能力较差，微量白蛋白尿的AUC为0.61，尿酸的AUC为0.49，eGFR的AUC为0.58。结论在无症状治疗的一级预防患者中，BNP筛查能够识别现有的沉默cTOD。 hs-cTnT 的性能不如 BNP。 B型利钠肽加hs-cTnT一起表现最好。使用 BNP +/- cTnT 进行预筛选，然后进行靶向表型分析，作为改善一级预防的可能方法，值得进一步探索。 (J Am Coll Cardiol 2012;60:960-8) (C) 2012 年，美国心脏病学会基金会
Objectives The aim of this study was to examine whether biomarkers can identify silent cardiac target organ damage (cTOD) in a primary prevention population.Background One possible way to improve primary prevention of cardiovascular events is to identify those patients who already harbor silent cTOD (i.e., myocardial ischemia, left ventricular hypertrophy, systolic dysfunction, diastolic dysfunction, or left atrial enlargement). This might be possible by screening with a biomarker (e.g. high sensitivity cardiac troponin T [hs-cTnT] or B-type natriuretic peptide [BNP]).Methods We prospectively recruited 300 asymptomatic individuals already receiving primary prevention therapy. Transthoracic echocardiography, stress echocardiography, and/or myocardial perfusion imaging were performed to identify silent cTOD.Results One hundred two (34%) patients had evidence of cTOD. Left ventricular hypertrophy was the most prevalent (29.7%) form of cTOD, followed by diastolic dysfunction (21.3%), left atrial enlargement (15.3%), systolic dysfunction (6.3%), and ischemia (6.3%). The area under the curve (AUC) for BNP to identify any form of silent cTOD was 0.78 overall and 0.82 in men. The equivalent figures for hs-cTnT were 0.70 and 0.75 in women. The AUC for BNP and hs-cTnT together was 0.81 and 0.82 in men. However, the discrimination power of other markers was poor, with AUCs of 0.61 for microalbuminuria, 0.49 for uric acid, and 0.58 for eGFR.Conclusions In asymptomatic treated primary prevention patients, BNP screening is able to identify existing silent cTOD. The performance of hs-cTnT was not as good as that of BNP. B-type natriuretic peptide plus hs-cTnT together performed best. Prescreening with BNP +/- cTnT followed by targeted phenotyping is worth exploring further as a possible way to improve primary prevention. (J Am Coll Cardiol 2012;60:960-8) (C) 2012 by the American College of Cardiology Foundation