Cardiac troponin T and NT-proBNP as diagnostic and prognostic biomarkers of primary cardiac involvement and disease severity in systemic sclerosis: A prospective study
Cardiac troponin T and NT-proBNP as diagnostic and prognostic biomarkers of primary cardiac involvement and disease severity in systemic sclerosis: A prospective study
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DOI：
10.1016/j.ejim.2018.10.013
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发表时间：
2019-02-01
影响因子：
8
通讯作者：
Ferraccioli, Gianfranco
中科院分区：
文献类型：
--
作者：
Bosello, Silvia;De Luca, Giacomo;Ferraccioli, Gianfranco
目的：本研究的目的是确定高敏感心肌肌钙蛋白T （hs-cTnT）和NT-proBNP在识别系统性硬化症（SSc）患者心脏受损伤和心源性死亡风险较高中的作用。方法：测定245例ssc患者血浆hs-cTnT和NT-proBNP浓度。结果：ssc患者hs-cTnT和NT-proBNP水平高于健康对照组。32.3% ssc患者Hs-cTnT水平高于0.014 ng/ml， 31.8% ssc患者NT-proBNP水平高于125 pg/ml，与经典心血管危险因素和肺动脉高压无关。hs-cTnT和NT-proBNP升高与弥漫性皮肤受累相关，并与皮肤评分直接相关。与心脏酶正常的患者相比，心脏标志物升高的患者在心电图上表现为较低的左心室射血分数（LVEF）和较高的右束支传导阻滞（RBBB）率。随访期间，12例ssc患者出现疾病相关死亡；其中9例与心脏受累（心源性猝死或心力衰竭）直接相关，其中大多数发生在至少一种心脏生物标志物升高的患者中。两种心脏生物标志物均升高的患者的长期生存率较差。结论：评估hs-cTnT和NT-proBNP水平可能为非侵入性ssc患者心脏受累提供一种工具。心肌酶升高的ssc患者收缩功能受损、心电图异常和预后差的发生率较高，这表明它们可能是早期检测心脏损伤和改善风险分层的有价值的筛选生物标志物。
Objectives: The aim of our study was to define the role of high-sensitive cardiac troponin T (hs-cTnT) and NT-proBNP in identifying Systemic Sclerosis (SSc) patients with cardiac involvement and at higher risk of cardiac death.Methods: Plasma hs-cTnT and NT-proBNP concentrations were measured in 245 SSc-patients.Results: hs-cTnT and NT-proBNP levels were higher in SSc-patients than in healthy controls. Hs-cTnT levels were higher than 0.014 ng/ml in 32.3% SSc-patients, while NT-proBNP was above 125 pg/ml in 31.8% of them, irrespective of classical cardiovascular risk factor and of pulmonary arterial hypertension. Elevated hs-cTnT and NT-proBNP were associated with diffuse skin involvement and directly correlated with the skin score. Patients with increased cardiac markers presented a lower left-ventricular ejection fraction (LVEF) and a higher rate of right bundle branch block (RBBB) on electrocardiogram (ECG) compared to patients with normal cardiac enzymes.During the follow-up, 12 SSc-patients experience a disease-related death; 9 of these were directly related to cardiac involvement (sudden cardiac death or heart failure) and the majority of them occurred among patients with increase of at least one cardiac biomarker. Long-term survival was worse in patients with increase of both cardiac biomarkers.Conclusions: Evaluation of hs-cTnT and NT-proBNP levels may provide a tool to screen non-invasively SSc-patients for heart involvement. A higher incidence of impaired systolic function, ECG abnormalities and a poor outcome in SSc-patients with elevated cardiac enzymes suggests that they may be valuable screening biomarkers to detect a cardiac damage at early stages and to improve risk stratification.