Relation of elevation in cardiac troponin I to clinical severity, cardiac dysfunction, and pulmonary congestion in patients with subarachnoid hemorrhage.
Relation of elevation in cardiac troponin I to clinical severity, cardiac dysfunction, and pulmonary congestion in patients with subarachnoid hemorrhage.
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DOI：
10.1016/j.amjcard.2008.07.053
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发表时间：
2008-12-01
影响因子：
2.8
通讯作者：
Gorcsan, John, III
中科院分区：
文献类型：
--
作者：
Tanabe, Masaki;Crago, Elizabeth A.;Suffoletto, Matthew S.;Hravnak, Marilyn;Frangiskakis, J. Michael;Kassam, Amin B.;Horowitz, Michael B.;Gorcsan, John, III
蛛网膜下腔出血（SAH）后常出现心肌肌钙蛋白I（cTnI）升高，但其意义尚不清楚。在SAHMII研究中前瞻性评价了103例SAH患者，以确定cTnI与临床严重程度、心脏收缩和舒张功能、肺充血和重症监护病房住院时间的关系。评价超声心动图射血分数、室壁运动评分、二尖瓣舒张早期血流速度（E）和二尖瓣环早期血流速度（E′）。cTnI轻度阳性（0.1 ~ 1.0ng/ml）30例（29%），高阳性（> 1.0ng/ml）24例（23%），阴性（<0.1ng/ml）49例（48%）。cTnI高阳性与神经系统疾病恶化、重症监护室停留时间延长和射血分数轻度降低相关（51 ± 11% [p <0.05] vs cTnI轻度阳性或阴性组分别为59 ± 8%和63 ± 6%）。高阳性cTnI也与急性室壁运动异常相关（>1.31 ng/ml; 76%敏感性，91%特异性），通常在5 - 10天内消退。cTnI轻度或高度阳性均与急性舒张功能不全相关，E/E′分别为17 ± 6和16 ± 6（均p <0.05），cTnI阴性患者为13 ± 4。cTnI高阳性患者肺充血的发生率为79%（p <0.05），cTnI轻度阳性患者为53%（p <0.05），cTnI阴性患者为29%。总之，SAH患者cTnI高阳性与临床神经系统严重程度、收缩期和舒张期心功能不全、肺充血和重症监护室住院时间延长相关。即使cTnI轻度升高也与舒张功能障碍和肺充血相关。
An increase in cardiac troponin I (cTnI) occurs often after aneurysmal subarachnoid hemorrhage (SAH), but its significance is not well understood. One hundred three patients with SAH were prospectively evaluated in the SAHMII Study to determine the relations of cTnI to clinical severity, systolic and diastolic cardiac function, pulmonary congestion, and length of intensive care unit stay. Echocardiographic ejection fraction, wall motion score, mitral inflow early diastolic (E) and mitral annular early (E′) velocities were assessed. Thirty patients (29%) had mildly positive cTnI (0.1 to 1.0 ng/ml), 24 (23%) had highly positive cTnI (>1.0 ng/ml), and 49 (48%) had negative cTnI (<0.1 ng/ml). Highly positive cTnI was associated with worse neurologic disease, longer intensive care unit stay, and slight depression of ejection fraction (51 ± 11% [p <0.05] vs 59 ± 8% and 63 ± 6% in mildly positive or negative cTnI groups, respectively). Highly positive cTnI was also associated with abnormal wall motion acutely (>1.31 ng/ml; 76% sensitivity, 91% specificity), which typically resolved within 5 to 10 days. Both mildly or highly positive cTnI were associated with acute diastolic dysfunction, with E/E′ of 17 ± 6 and 16 ± 6 (both p <0.05) vs 13 ± 4 in patients with negative cTnI. Prevalences of pulmonary congestion were 79% (p <0.05) in patients with highly positive cTnI, 53% (p <0.05) in patients with mildly positive cTnI, and 29% in cTnI-negative patients. In conclusion, highly positive cTnI with SAH was associated with clinical neurologic severity, systolic and diastolic cardiac dysfunction, pulmonary congestion, and longer intensive care unit stay. Even mild increases in cTnI were associated with diastolic dysfunction and pulmonary congestion.
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发表时间：
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影响因子：
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作者：
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