Distribution and specificity of high-sensitivity cardiac troponin T in older adults without acute cardiac conditions: cross-sectional results from the population-based AugUR study.
Distribution and specificity of high-sensitivity cardiac troponin T in older adults without acute cardiac conditions: cross-sectional results from the population-based AugUR study.
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在没有急性心脏条件的老年人中，高敏性心脏肌钙蛋白T的分布和特异性：基于人群的Augur研究的横断面结果。
DOI：
10.1136/bmjopen-2021-052004
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发表时间：
2021-11-02
期刊：
影响因子：
2.9
通讯作者：
Stark KJ
中科院分区：
文献类型：
--
作者：
Dietl A;Zimmermann ME;Brandl C;Wallner S;Burkhardt R;Maier LS;Luchner A;Heid IM;Stark KJ
欧洲指南推荐了一个统一的高敏心肌肌钙蛋白T（hsTnT）参考上限，以排除非ST段抬高心肌梗死。我们的研究旨在提供hsTnT参考分布，并评估≥70岁移动的人群中14 ng/L临界值的特异性。在德国AugUR研究（里根斯堡大学的Altersbezogene Untersuchungen zur Gesundelder）中进行了横断面分析。研究人群为居住在德国里根斯堡市县的70岁以上的移动的人群。从当地居民登记处随机抽取样本。在5644名被邀请的个人中，有1133人参加（应答率=20.1%）。所有参与者都来到研究中心，并在精神和身体上移动的进行方案（面对面访谈、抽血和标准化经胸超声心动图）。没有参与者处于心肌梗死的急性状态。在1129名hsTnT检测的个体中，（总体中位数=10.0 ng/L（第25、75百分位数）=（7.0，15.0 ng/L）），老年人hsTnT高于男性（70-74岁男性中位数=9.6纳克/升（7.2，13.1纳克/升）; 90-95岁男性中位数=21.2纳克/升）（14.6、26.0纳克/升）; 70-74岁妇女中位数=6.3纳克/升（4.7、8.7纳克/升）; 90-95岁妇女中位数=18.0纳克/升（11.0、21.0纳克/升））。在肾功能受损（eGFRcrea <60 mL/min/1.73 m2）的参与者中，hsTnT升高（中位数=13.6 ng/L（9.4，20.6 ng/L））。建议的参考上限14 ng/L的专属性为68%。大多数假阳性发生在年龄>79岁的男性中（特异性=34%）。在健康亚组中（n=96，无以下情况：明显心脏病、肾功能受损、血压>160/100 mm Hg、左心室肥大和舒张/收缩功能障碍），特异性为90%。在无急性心肌梗死的老年人群中，hsTnT随着年龄的增长而进一步升高，显示出男性和女性的不同水平。即使在健康受试者中，14 ng/L临界值的特异性也远低于99%。
European guidelines recommended a uniform upper reference limit of high-sensitivity cardiac troponin T (hsTnT) to rule out non-ST segment elevation myocardial infarction. Our study aimed to provide a hsTnT reference distribution and to assess the specificity of the 14 ng/L cut-off value in the mobile population ≥70 years of age. A cross-sectional analysis was performed in the German AugUR study (Altersbezogene Untersuchungen zur Gesundheit der University of Regensburg). Study population was the mobile population aged 70+ years living in the city and county of Regensburg, Germany. A random sample was derived from the local population registries of residence. Of the 5644 individuals invited, 1133 participated (response ratio=20.1%). All participants came to the study centre and were mentally and physically mobile to conduct the protocol (face-to-face interview, blood draw and standardised transthoracic echocardiography). None of the participants was in an acute state of myocardial infarction. Among the 1129 individuals with hsTnT measurements (overall median=10.0 ng/L (25th, 75th percentile)=(7.0, 15.0 ng/L)), hsTnT was higher among the older individuals and higher among men (men 70–74 years median=9.6 ng/L (7.2, 13.1 ng/L); men 90–95 years median=21.2 ng/L (14.6, 26.0 ng/L); women 70–74 years median=6.3 ng/L (4.7, 8.7 ng/L); and women 90–95 years median=18.0 ng/L (11.0, 21.0 ng/L)). In participants with impaired kidney function (eGFRcrea <60 mL/min/1.73 m2), hsTnT was elevated (median=13.6 ng/L (9.4, 20.6 ng/L)). Specificity of recommended upper reference limit, 14 ng/L, is 68%. Most false positives were among men aged >79 years (specificity=34%). In a healthy subgroup (n=96, none of the following: overt heart disease, impaired renal function, blood pressure >160/100 mm Hg, left ventricular hypertrophy and diastolic/systolic dysfunction), specificity was 90%. In the elderly population without acute myocardial infarction, hsTnT further increases with age showing different levels for men and women. The specificity of the 14 ng/L cut-off is considerably lower than 99%, even in healthy subjects.
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