Association of serial measures of cardiac troponin T using a sensitive assay with incident heart failure and cardiovascular mortality in older adults.
Association of serial measures of cardiac troponin T using a sensitive assay with incident heart failure and cardiovascular mortality in older adults.
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DOI：
10.1001/jama.2010.1708
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发表时间：
2010-12-08
影响因子：
120.7
通讯作者：
Seliger, Stephen L.
中科院分区：
文献类型：
--
作者：
deFilippi, Christopher R.;de Lemos, James A.;Christenson, Robert H.;Gottdiener, John S.;Kop, Willem J.;Zhan, Min;Seliger, Stephen L.
老年人占新发心力衰竭 (HF) 诊断的大多数，但传统的危险因素预测模型在该人群中识别住院或死亡风险最高的人群的准确性有限。旨在确定通过高灵敏度测定法测量的心肌肌钙蛋白 T (cTnT) 是否可以在大多数社区居住的老年人中检测到，以及一系列测量是否与心力衰竭住院和心血管死亡风险相关。一项全国性纵向队列研究（心血管健康研究），对象为 4221 名年龄在 65 岁或以上、无心衰史的社区居民，他们在基线（1989-1990 年）使用高灵敏度测定法测量了 cTnT，并在 2 至 3 年后重复进行了测量（n = 2918）。截至 2008 年 6 月，我们对新发心力衰竭和心血管死亡的 cTnT 浓度进行了检查，以解释临床风险预测因素。 2794 名参与者 (66.2%) 中可检测到心肌肌钙蛋白 T (≥3.00 pg/mL)。在中位随访 11.8 年期间，1279 名参与者经历了新发心力衰竭，1103 名参与者发生心血管死亡，这两个终点的风险都与较高的 cTnT 浓度相关。在 cTnT 浓度最高 (>12.94 pg/mL) 的参与者中，心力衰竭的发病率为每 100 人年 6.4（95% 置信区间 [CI]，5.8–7.2；调整后的风险比 [aHR]，2.48；95% CI，2.04–3.00），心力衰竭的发病率为 4.8（95% CI，与未检测到 cTnT 水平的参与者相比，心血管死亡的发生率为 4.3-5.4；aHR，2.91；95% CI，2.37-3.58（心力衰竭和心血管死亡的发生率分别为 1.6；95% CI，1.4-1.8 和 1.1；95% CI，0.9-1.2）。在最初可检测到 cTnT 的个体中，随后增加超过 50% (n = 393, 22%) 与心力衰竭 (aHR, 1.61; 95% CI, 1.32–1.97) 和心血管死亡 (aHR, 1.65; 95% CI, 1.35–2.03) 的风险增加相关，并且下降超过 50% (n = 247, 14%) 与变化 50% 或更少的参与者相比，心力衰竭 (aHR, 0.73; 95% CI, 0.54–0.97) 和心血管死亡 (aHR, 0.71; 95% CI, 0.52–0.97) 风险较低。将基线 cTnT 测量值添加到临床危险因素中仅与区分度略有改善相关，心力衰竭的 C 统计量变化为 0.015，心血管死亡的 C 统计量变化为 0.013。在这组不知道心力衰竭的老年人中，基线 cTnT 水平和用高灵敏度测定法测量的 cTnT 水平变化与心力衰竭和心血管死亡显着相关。
Older adults comprise the majority of new-onset heart failure (HF) diagnoses, but traditional risk-factor prediction models have limited accuracy in this population to identify those at highest risk for hospitalization or death. To determine if cardiac troponin T (cTnT) measured by a highly sensitive assay would be detectable in the majority of community-dwelling older adults, and if serial measures were associated with risk of HF hospitalization and cardiovascular death. A longitudinal nationwide cohort study (Cardiovascular Health Study) of 4221 community-dwelling adults aged 65 years or older without prior HF who had cTnT measured using a highly sensitive assay at baseline (1989–1990) and repeated after 2 to 3 years (n = 2918). New-onset HF and cardiovascular death were examined through June 2008 with respect to cTnT concentrations, accounting for clinical risk predictors. Cardiac troponin T was detectable (≥3.00 pg/mL) in 2794 participants (66.2%). During a median follow-up of 11.8 years, 1279 participants experienced new-onset HF and 1103 cardiovascular deaths occurred, with a greater risk of both end points associated with higher cTnT concentrations. Among those participants with the highest cTnT concentrations (>12.94 pg/mL), there was an incidence rate per 100 person-years of 6.4 (95% confidence interval [CI], 5.8–7.2; adjusted hazard ratio [aHR], 2.48; 95% CI, 2.04–3.00) for HF and an incidence rate of 4.8 (95% CI, 4.3–5.4; aHR, 2.91; 95% CI, 2.37–3.58) for cardiovascular death compared with participants with undetectable cTnT levels (incidence rate, 1.6; 95% CI, 1.4–1.8 and 1.1; 95% CI, 0.9–1.2 for HF and cardiovascular death, respectively). Among individuals with initially detectable cTnT, a subsequent increase of more than 50% (n = 393, 22%) was associated with a greater risk for HF (aHR, 1.61; 95% CI, 1.32–1.97) and cardiovascular death (aHR, 1.65; 95% CI, 1.35–2.03) and a decrease of more than 50% (n = 247, 14%) was associated with a lower risk for HF (aHR, 0.73; 95% CI, 0.54–0.97) and cardiovascular death (aHR, 0.71; 95% CI, 0.52–0.97) compared with participants with 50% or less change. Addition of baseline cTnT measurements to clinical risk factors was associated with only modest improvement in discrimination, with change in C statistic of 0.015 for HF and 0.013 for cardiovascular death. In this cohort of older adults without known HF, baseline cTnT levels and changes in cTnT levels measured with a highly sensitive assay were significantly associated with incident HF and cardiovascular death.
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