Association between high-sensitivity cardiac troponin T and future cardiovascular incidence in a general Japanese population: results from the Tohoku medical megabank project

Purpose: Elevation of high-sensitivity cardiac troponin T (hs-cTnT) is associated with an increased risk of cardiovascular disease (CVD). This study determined whether hs-cTnT was detectable with N-terminal pro-b-type natriuretic peptide (NT-proBNP) and related to CV risk factors in a general Japanese population.

Materials and methods: The Tohoku Medical Megabank Organization pooled individual participant data for a population-based cohort study in the Iwate prefecture (n?=?30,193, age = 60.2?±?11.5?year).

Results: Hs-cTnT levels were higher in participants with hypertension, diabetes mellitus than in participants without these conditions (all ps < 0.001). Logistic regression analysis demonstrated that NT-proBNP was strongly associated with elevation of hs-cTnT (OR = 3.35, 95% CI = 2.90–3.89, p?<?0.001). The receiver operating characteristic curve analysis showed that hs-cTnT was one of useful biomarker for the differentiation of high risk for CVD (the Suita score ≥ 56) from a general population. Logistic regression analysis demonstrated hs-cTnT levels were related to the CVD high risk group (OR = 2.67, 95% CI = 2.28–3.14, p?<?0.001).

Conclusions: Hs-cTnT levels are associated with elevation of NT-proBNP and high Suita score, which suggests that elevated hs-cTnT is related to subclinical myocardial damage and indicates CV risk.     

High-sensitivity cardiac troponin T: risk stratification tool in patients with symptoms of chest discomfort

Background

Recent studies have demonstrated the association between increased concentrations of high-sensitivity cardiac troponin T (hs-cTnT) and the incidence of myocardial infarction, heart failure, and mortality. However, most prognostic studies to date focus on the value of hs-cTnT in the elderly or general population. The value of hs-cTnT in symptomatic patients visiting the outpatient department remains unclear. The aim of this study was to investigate the prognostic value of hs-cTnT as a biomarker in patients with symptoms of chest discomfort suspected for coronary artery disease and to assess its additional value in combination with other risk stratification tools in predicting cardiac events.

Methods

We studied 1,088 patients (follow-up 2.2±0.8 years) with chest discomfort who underwent coronary calcium scoring and coronary CT-angiography. Traditional cardiovascular risk factors and concentrations of hs-cTnT, N-terminal pro-brain-type natriuretic peptide (NT-proBNP) and high-sensitivity C-reactive protein (hsCRP) were assessed. Study endpoint was the occurrence of late coronary revascularization (>90 days), acute coronary syndrome, and cardiac mortality.

Results

Hs-cTnT was a significant predictor for the composite endpoint (highest quartile [Q4]>6.7 ng/L, HR 3.55; 95%CI 1.88–6.70; P<0.001). Survival analysis showed that hs-cTnT had significant predictive value on top of current risk stratification tools (Chi-square change P<0.01). In patients with hs-cTnT in Q4 versus P<0.01). This was not the case for hsCRP and NT-proBNP.

Conclusions

Hs-cTnT is a useful prognostic biomarker in patients with chest discomfort suspected for coronary artery disease. In addition, hs-cTnT was an independent predictor for cardiac events when corrected for cardiovascular risk profiling, calcium score and CT-angiography results.     

Circulating biomarkers of hypertrophy and fibrosis in patients with hypertrophic cardiomyopathy assessed by cardiac magnetic resonance

Abstract

Background: Myocardial fibrosis in hypertrophic cardiomyopathy (HCM) is associated with worse clinical outcomes. The availability of circulating biomarkers of myocardial fibrosis and hypertrophy would be helpful in clinical practice.

Objective: The aim of this study was to evaluate usefulness of various biomarkers of myocardial fibrosis and hypertrophy in HCM.

Methods: Levels of biomarkers: soluble ST2 (sST2), galectin-3 (Gal-3), growth differentiation factor-15 (GDF-15), NT-proBNP and high-sensitivity cardiac troponin T (hs-cTnT) were measured in 60 patients with HCM. All patients underwent cardiac magnetic resonance imaging to calculate parameters of hypertrophy and fibrosis.

Results: We observed positive correlations among sST2 levels and left ventricular mass (LVM) (r?=?0.32, p?=?0.012), LV mass indexed for the body surface area (LVMI) (r?=?0.27, p?=?0.036) and maximal wall thickness (MWT) (r?=?0.31, p?=?0.015). No correlation was found between Gal-3 and GDF-15 levels and hypertrophy and fibrosis parameters. We observed positive correlations among hs-cTnT levels and LVM (r?=?0.58, p?<?0.0001), LVMI (r?=?0.48, p?=?0.0001), MWT (r?=?0.31, p?=?0.015) and late gadolinium enhancement (LGE) mass (r?=?0.37, p?=?0.003). There were positive correlations between NT-proBNP levels and LVM (r?=?0.33, p?=?0.01), LVMI (r?=?0.41, p?=?0.001), MWT (r?=?0.42, p?<?0.001) and LGE mass (r?=?0.44, p?<?0.001).

Conclusions: Although no correlation between sST2 levels and myocardial fibrosis was found, sST2 may provide some additional information about hypertrophy extension. NT-proBNP and hs-cTnT are useful biomarkers in assessment of hypertrophy and fibrosis in HCM.     

坐式八段锦联合运动康复治疗对急性冠脉综合征PCI术后患者运动耐力、血清心肌损伤标志物和生活质量的影响

摘要 目的：探讨坐式八段锦联合运动康复治疗对急性冠脉综合征（ACS）经皮冠状动脉介入治疗术（PCI）后患者运动耐力、血清心肌损伤标志物和生活质量的影响。方法：根据随机数字表法,将我院2020年4月~2021年5月期间收治的ACS行PCI术的患者（n=120）分为对照组（运动康复治疗,n=60）和研究组（坐式八段锦联合运动康复治疗,n=60）。对比两组心功能指标[左心室舒张末期内径（LVEDD）、左心室射血分数（LVEF）、氨基末端B型脑利钠肽前体（NT-proBNP）、左心室舒张末期容积（LVEDV）]、心肌损伤标志物[肌酸激酶同工酶（CK-MB）、心肌肌钙蛋白I（cTnI）]、运动耐力指标[无氧阈（AT）、最大摄氧量（VO_2max ）、运动持续时间（ED）]和生活质量[西雅图心绞痛量表（SAQ）评分：躯体活动受限程度（PL）、心绞痛稳定情况（AS）、疾病认知程度（DS）、心绞痛发作状况（AF）和治疗满意程度（TS）],并纪录两组不良心血管事件发生情况。结果：研究组的心血管不良事件发生率低于对照组（P<0.05）。研究组治疗3个月后LVEF高于对照组,LVEDD、LVEDV、NT-proBNP低于对照组（P<0.05）。研究组治疗3个月后CK-MB、cTnI低于对照组（P<0.05）。研究组治疗3个月后AT、VO_2max 、ED高于对照组（P<0.05）。研究组治疗3个月后PL、AS、DS、AF、TS评分高于对照组（P<0.05）。结论：坐式八段锦联合运动康复治疗可促进ACS患者PCI术后心功能改善,减轻心肌损伤,进而提高运动耐力和生活质量。     

Prognostic Role of Ventricular Ectopic Beats in Systemic Sclerosis: A Prospective Cohort Study Shows ECG Indexes Predicting the Worse Outcome

BackgroundArrhythmias are frequent in Systemic Sclerosis (SSc) and portend a bad prognosis, accounting alone for 6% of total deaths. Many of these patients die suddenly, thus prevention and intensified risk-stratification represent unmet medical needs. The major goal of this study was the definition of ECG indexes of poor prognosis.MethodsWe performed a prospective cohort study to define the role of 24h-ECG-Holter as an additional risk-stratification technique in the identification of SSc-patients at high risk of life-threatening arrhythmias and sudden cardiac death (SCD). One-hundred SSc-patients with symptoms and/or signs suggestive of cardiac involvement underwent 24h-ECG-Holter. The primary end-point was a composite of SCD or need for implantable cardioverter defibrillator (ICD).ResultsFifty-six patients (56%) had 24h-ECG-Holter abnormalities and 24(24%) presented frequent ventricular ectopic beats (VEBs). The number of VEBs correlated with high-sensitive cardiac troponin T (hs-cTnT) levels and inversely correlated with left-ventricular ejection fraction (LV-EF) on echocardiography. During a mean follow-up of 23.1±16.0 months, 5 patients died suddenly and two required ICD-implantation. The 7 patients who met the composite end-point had a higher number of VEBs, higher levels of hs-cTnT and NT-proBNP and lower LV-EF (p = 0.001 for all correlations). All these 7 patients had frequent VEBs, while LV-EF was not reduced in all and its range was wide. At ROC curve, VEBs>1190/24h showed 100% of sensitivity and 83% of specificity to predict the primary end-point (AUROC = 0.92,p<0.0001). Patients with VEBS>1190/24h had lower LV-EF and higher hs-cTnT levels and, at multivariate analysis, the presence of increased hs-cTnT and of right bundle branch block on ECG emerged as independent predictors of VEBs>1190/24h. None of demographic or disease-related characteristics emerged as predictors of poor outcome.ConclusionsVEBS>1190/24h identify patients at high risk of life-threatening arrhythmic complications. Thus, 24h-ECG-Holter should be considered a useful additional risk-stratification test to select SSc-patients at high-risk of SCD, in whom an ICD-implantation could represent a potential life-saving intervention.     

心脏瓣膜疾病患者术后危险因素及潜在预测指标初探

目的:评价心肌肌钙蛋白(cardiac troponin,c Tn T)、氨基末端脑钠肽前体(N-terminal pro·-brain natriuretic peptide,NT-pro BNP)对于心瓣膜疾病手术患者术后并发症的预测价值。方法:选取我院2014年1月~2015年12月收治的心瓣膜病患者共108例,入院即记录其年龄、性别、BMI指数、NYHA等,于患者出院1个月后开始随访,随访时间为18个月,根据随访结局分为预后良好组与预后不良组。生存曲线显示随访后的不良预后率;单因素、多因素Cox回归评价各因素对患者预后情况的影响程度;ROC曲线分析其对疾病预后的预测价值。结果:多因素Cox回归分析显示左心室舒张末期内径(left ventricular end-diastolic dimension,LVEDD)(P=0.022)、c Tn T(P=0.023)和NT-pro BNP(P=0.016)对患者术后不良预后存在影响,其中,LVEDD的影响程度最高(RR=2.142),其次为NT-pro BNP(RR=2.046);ROC曲线下NT-pro BNP联合c Tn T预测的AUC为0.856,其特异性为83.6%,敏感性为79.3%。结论:NT-pro BNP联合BNP对心瓣膜置换术后患者的预后有较好的预测价值。     

先天性心脏病患儿介入封堵术治疗前后CRP、NT-proBNP、心率变异性的变化及与术后心功能的关系研究

摘要 目的：探讨先天性心脏病（CHD）患儿介入封堵术治疗前后C-反应蛋白（CRP）、N末端B型利钠肽原（NT-proBNP）、心率变异性（HRV）的变化及与术后心功能的关系。方法：选择2020年10月至2021年6月在本院行介入封堵术治疗的95例CHD患儿为研究对象,采用化学发光法检测血清CRP水平,采用电化学发光免疫技术检测血清NT-proBNP水平,采用24 h动态心电图及12导联同步心电图分析HRV指标,观察手术前后患儿的血清CRP、NT-proBNP水平及HRV指标变化,比较术后不同NYHA心功能分级患儿的血清CRP、NT-proBNP水平和HRV指标,分析患儿术前血清CRP水平、血清NT-proBNP水平、HRV指标与术后NYHA心功能分级的相关性。结果：介入封堵术后患儿血清CRP、NT-proBNP、LF/HF水平逐渐降低,术后3 d、术后1个月时均低于术前,术后1个月时均低于术后3 d时（P<0.025）;而TP、HF、LF、R-R、PNN50%、ASDNN、SDANN、SDNN、rMSSD水平逐渐升高,术后3 d、术后1个月时均高于术前,术后1个月时均高于术后3 d 时（P<0.025）。患儿术后3 d的血清CRP、NT-proBNP水平及LF/HF水平随着NYHA心功能分级的升高而升高,TP、HF、LF、R-R、PNN50%、ASDNN、SDANN、SDNN、rMSSD水平随着NYHA心功能分级的升高而降低（多有P＜0.05）。患儿术后3 d的NYHA心功能分级与治疗前血清CRP、NT-proBNP及LF/HF水平呈负相关,与TP、HF、LF、R-R、PNN50%、ASDNN、SDANN、SDNN、rMSSD水平呈正相关（P＜0.05）。结论：CHD患儿经介入封堵术治疗后,血清CRP、NT-proBNP及HRV指标变化明显,与术后NYHA心功能分级显著相关,血清CRP、NT-proBNP及HRV指标有望成为评估CHD患儿介入封堵术后预后的较敏感性指标。     

慢性心力衰竭患者血清Galectin-3、hs-cTnT、Cys C和PTX-3水平变化及临床意义

目的:研究慢性心力衰竭(CHF)患者血清半乳糖凝聚素-3(Galectin-3)、高敏肌钙蛋白-T(hs-cTnT)、胱抑素C(Cys C)和正五聚体蛋白-3(PTX-3)水平变化及临床意义。方法:选择2017年2月～2018年6月我院收治的CHF患者100例,按照美国心脏病协会(NYHA)心功能分级标准将其分成NYHAⅡ级组39例、NYHAⅢ级组33例、NYHAⅣ级组28例,根据随访1年患者预后情况将主要心脏不良事件患者记作预后不良组(n=27),其余记为预后优良组(n=73),另取同期于我院进行体检的健康者30例作为对照组。分别比较CHF患者和对照组的心功能指标、血清Galectin-3、hs-cTnT、Cys C、PTX-3水平,分析CHF患者上述指标的相关性及其与CHF预后情况的关系。结果:对照组、NYHAⅡ级组、NYHAⅢ级组、NYHAⅣ级组左心室舒张末期内径(LVEDD)呈逐渐增大趋势,而左心室射血分数(LVEF)呈逐渐降低趋势(P0.05)。对照组、NYHAⅡ级组、NYHAⅢ级组、NYHAⅣ级组血清Galectin-3、hs-cTnT、Cys C和PTX-3水平呈逐渐升高趋势(P0.05)。经Pearson相关性分析可得:CHF患者LVEDD与血清Galectin-3、hs-cTnT、Cys C、PTX-3水平呈正相关关系,而LVEF与血清Galectin-3、hs-cTnT、Cys C、PTX-3水平呈负相关关系(P0.05)。CHF预后优良组血清Galectin-3、hs-cTnT、Cys C、PTX-3水平均低于预后不良组(P0.05)。结论:CHF血清Galectin-3、hs-cTnT、Cys C和PTX-3水平均呈明显高表达,且与患者的病情严重程度呈密切相关,临床上可通过检测上述指标水平,继而为CHF临床诊断、预后评估提供参考依据。     

High-Sensitivity Cardiac Troponin Concentrations in Patients with Chest Discomfort: Is It the Heart or the Kidneys As Well?

BackgroundHigh-sensitivity cardiac troponins (hs-cTn) are the preferred biomarkers to detect myocardial injury, making them promising risk-stratifying tools for patients with symptoms of chest pain. However, circulating hs-cTn are also elevated in other conditions like renal dysfunction, complicating appropriate interpretation of low-level hs-cTn concentrations.MethodsA cross-sectional analysis was performed in 1864 patients with symptoms of chest discomfort from the cardiology outpatient department who underwent cardiac computed tomographic angiography (CCTA). Serum samples were analyzed using hs-cTnT and hs-cTnI assays. Renal function was measured by the estimated glomerular filtration rate (eGFR), established from serum creatinine and cystatin C. On follow-up, the incidence of adverse events was assessed.ResultsMedian hs-cTnT and hs-cTnI concentrations were 7.2(5.8–9.2) ng/L and 2.6(1.8–4.1) ng/L, respectively. Multivariable regression analysis revealed that both assay results were more strongly associated with eGFR (hs-cTnT:stβ:-0.290;hs-cTnI:stβ:-0.222) than with cardiac imaging parameters, such as coronary calcium score, CCTA plaque severity score and left ventricular mass (all p<0.01). Furthermore, survival analysis indicated lower relative risks in patients with normal compared to reduced renal function for hs-cTnT [HR(95%CI), 1.02(1.00–1.03) compared to 1.07(1.05–1.09)] and hs-cTnI [1.01(1.00–1.01) compared to 1.02(1.01–1.02)] (all p<0.001).ConclusionIn patients with chest discomfort, we identified an independent influence of renal function on hs-cTn concentrations besides CAD, that affected the association of hs-cTn concentrations with adverse events. Estimating renal function is therefore warranted when interpreting baseline hs-cTn concentrations.     

替罗非班联合尼可地尔对急诊PCI患者心功能和短期预后的影响

目的:探讨急诊PCI患者在联合使用替罗非班和尼可地尔后对心功能和短期预后的影响。方法:入选98例接受急诊PCI的AMI患者随机分为对照组(n=49)和联合治疗组(n=49)。对照组单纯给予替罗非班治疗,联合治疗组在对照组基础上给予尼可地尔5 mg tid口服治疗。观察记录两组患者治疗8周前后LVEF、NT-pro BNP水平,并随访MACE事件发生情况。结果:两组患者在治疗前LVEF及NT-pro BNP水平比较没有统计学差异(P0.05)。在治疗8周后联合治疗组和对照组LVEF及NT-pro BNP水平均较治疗前水平明显改善(P0.05)。治疗8周后联合治疗组患者LVEF及NT-pro BNP水平明显优于对照组患者(P0.05)。经过8周的治疗,联合治疗组再次发生心绞痛事件(6.12%VS 24.49%,P=0.025)、恶性心律失常(2.04%VS 16.33%,P=0.036)和心力衰竭事件(2.04%VS 18.37%,P=0.020)明显低于对照组。结论:替罗非班联合尼可地尔可进一步改善急诊PCI患者心功能及短期预后,值得临床推广。     

CK-MBmass, hs-cTnT及CK-MB与急性心肌梗死的相关性及其联合诊断价值

摘要 目的：研究肌酸激酶同工酶质量（CK-MBmass)、肌酸激酶同工酶（CK-MB）和高敏心肌肌钙蛋白T（hs-cTnT）在急性心肌梗死患者（AMI）血清中的含量,并探讨三者联合对AMIDE诊断价值。方法：选择2018年1月到2021年10月我院收治的AMI患者90例作为研究组,并选择同期在我院体检健康志愿者40例作为对照组,比较两组AMI患者血清CK-MBmass,hs-cTnT和CK-MB。根据Killp分级法将不同心力衰竭将AMI患者分为II、III和IV级,并根据心肌梗死范围将AMI患者分为轻度、中度和重度心肌梗死组。比较不同AMI患者血清CK-MBmass,hs-cTnT和CK-MB。通过受试者工作曲线计算血清CK-MBmass,hs-cTnT和CK-MB联合诊断AMI的阳性预测值、阴性预测值、敏感度和特异度。结果：（1）AMI患者血清CK-MBmass,hs-cTnT和CK-MB均显著高于健康志愿者（P<0.05）;（2）AMI患者血清CK-MBmass,hs-cTnT和CK-MB随Killp分级或心肌梗死范围升高而升高（P<0.05）;（3）AMI患者血清CK-MBmass,hs-cTnT,CK-MB与急性心肌梗死患者左室射血分数（LVEF）呈负相关（P<0.05）,与左室舒张末期容积（LVEDd）和梗死范围呈正相关（P<0.05）;（4）血清CK-MBmass,hs-cTnT和CK-MB联合检测急性心肌梗死的阳性预测值、阴性预测值、敏感度和特异度均高于单独诊断。结论：血清CK-MBmass,hs-cTnT和CK-MB在AMI患者含量升高,并且与患者心功能和心肌梗死范围有关,适用于AMI的联合诊断。     

High sensitivity cardiac troponin T in patients not having an acute coronary syndrome: results from the TRAPID-AMI study

Purpose: To describe the baseline, 1?hr and delta high sensitivity cardiac troponin (hs-cTnT) values in patients with suspected acute myocardial infarction (AMI) but without a final acute coronary syndrome (ACS) diagnosis.

Materials and methods: hs-cTnT assay for RAPID rule out of acute myocardial infarction (TRAPID-AMI) was a prospective diagnostic trial that enrolled emergency department (ED) patients with suspected AMI. Final patient diagnoses were adjudicated by a clinical events committee and subjects placed in different clinical groups: AMI, unstable angina, non-ACS cardiac, non-cardiac and unknown origin. The baseline, 1?hr and delta hs-cTnT values were analysed in the 902 non-ACS patients.

Results: Amongst the 1282 studied the patient groups were 213 (17%) AMI, 167 (13%) unstable angina, 113 (9%) non-ACS cardiac, 288 (22%) non-cardiac and 501 (39%) unknown origin. The hs-cTnT values in the non-cardiac and unknown origin groups were combined. The median hs-cTnT values (ng/L) were higher (p?<?0.001) in the non-ACS cardiac compared to the non-cardiac/unknown origin group at baseline (11.8,?<5) and 1?hr (12.3,?<5). Their negative predictive values were 0.955 (baseline) and 0.954 (1?hr) for predicting non-ACS cardiac versus non-cardiac/unknown origin diagnoses.

Conclusions: Hs-cTnT may help predict whether non-ACS ED patients have a final non-ACS cardiac or non-cardiac/unknown origin diagnoses.     

Matrix metalloproteinases as candidate biomarkers in adults with congenital heart disease

Context Matrix metalloproteinases (MMPs) are associated with diastolic dysfunction and heart failure in acquired heart disease.

Objective To investigate the role of MMPs as novel biomarkers in clinically stable adults with congenital heart disease.

Methods We measured serum MMP-2, -3, -9 and tissue inhibitor of matrix metalloproteinase-1 in 425 patients and analysed the association with cardiac function and exercise capacity.

Results MMP-2 was significantly associated with exercise capacity, ventilatory efficiency and left ventricular deceleration time, independently of age, sex, body surface area and NT-proBNP.

Conclusion MMP-2 may provide new information in the clinical evaluation of adults with congenital heart disease.     

慢性肺源性心脏病患者血清白细胞介素-6、降钙素原、D-二聚体、N端B型脑钠肽前体与心功能分级和预后的关系研究

摘要 目的：探讨慢性肺源性心脏病（CCP）患者血清白细胞介素-6（IL-6）、降钙素原（PCT）、D-二聚体（D-D）、N端B型脑钠肽前体（NT-proBNP）与心功能分级和预后的关系。方法：选取2020年1月～2021年5月合肥市第一人民医院全科医学科及呼吸与危重症科收治的170例CCP患者（CCP组）,其中纽约心脏协会（NYHA）心功能分级Ⅱ级49例、Ⅲ级66例、Ⅳ级55例,根据1年后存活状况分为死亡组26例和存活组144例,另选取同期54名体检健康者（对照组）。收集CCP患者临床资料,采用酶联免疫吸附法检测血清IL-6、PCT、D-D、NT-proBNP水平。通过多因素Logistic回归分析CCP患者预后不良的影响因素,受试者工作特征（ROC）曲线分析血清IL-6、PCT、D-D、NT-proBNP水平对CCP患者预后不良的预测价值。结果：与对照组比较,CCP组血清IL-6、PCT、D-D、NT-proBNP水平升高（P＜0.05）。Ⅱ级、Ⅲ级、Ⅳ级CCP患者血清IL-6、PCT、D-D、NT-proBNP水平依次升高（P＜0.05）。单因素分析显示,死亡组NYHA心功能分级Ⅳ级、肺动脉收缩压、Tie指数和血清IL-6、PCT、D-D、NT-proBNP水平高于存活组,第1秒用力呼气容积（FEV₁）占预计值％、FEV₁/用力肺活量（FVC）、三尖瓣环收缩期位移低于存活组（P＜0.05）。多因素Logistic回归分析显示,NYHA心功能分级Ⅳ级和肺动脉收缩压、IL-6、PCT、D-D、NT-proBNP升高为CCP患者预后不良的独立危险因素,FEV1占预计值％升高为独立保护因素（P＜0.05）。ROC曲线分析显示,血清IL-6、PCT、D-D、NT-proBNP水平单独与联合预测CCP患者预后不良的曲线下面积分别为0.789、0.789、0.792、0.801、0.954,灵敏度分别为93.33％、66.67％、66.67％、86.67％、86.67％,特异度分别为46.67％、82.67％、85.33％、66.67％、94.67％。血清IL-6、PCT、D-D、NT-proBNP水平联合预测CCP患者预后不良的AUC大于单项预测（P＜0.05）。结论：CCP患者血清IL-6、PCT、D-D、NT-proBNP水平升高可增加心功能严重程度并导致预后不良,可作为CCP患者预后不良的辅助预测指标,且四项指标联合检测具有更好的预测效能。     

富马酸比索洛尔对老年慢性心力衰竭患者血清胆红素、NT-proBNP及运动耐力的影响

摘要 目的：探究富马酸比索洛尔对老年慢性心力衰竭患者血清胆红素、N-末端B型利钠肽原（N-Terminal pro-brain natriuretic peptide,NT-proBNP）及运动耐力的影响。方法：选择我院于2017年1月~2020年1月收治的老年慢性心力衰竭患者80例,根据入院顺序经随机数字表法分成两组,对照组40例患者仅采用常规治疗方案进行治疗,研究组40例患者在常规治疗基础上联合富马酸比索洛尔进行治疗。对比两组患者治疗总有效率、左心室射血分数（left ventricular ejection fraction,LVEF）、心排量（cardiac output,CO）、每搏输出量（stroke volume,SV）、血清 NT-proBNP水平、6 min 步行测试距离、总胆红素、直接胆红素水平。结果：研究组的治疗总有效率90.00 %,显著高于对照组72.50 %（P＜0.05）; 治疗前,两组的LVEF、CO、SV水平对比无差异（P＞0.05）;治疗后,两组的LVEF、CO、SV水平均升高,且研究组更高（P＜0.05）;治疗前,两组的NT-proBNP水平及6 min 步行测试距离对比无显著性差异（P＞0.05）;治疗后,两组的NT-proBNP水平比治疗前均显著降低、6 min 步行测试距离比治疗前均显著升高,且研究组更优（P＜0.05）;治疗前,两组的总胆红素、直接胆红素水平对比无差异（P＞0.05）;治疗后,两组的总胆红素、直接胆红素水平均比治疗前显著降低,且研究组显著低于对照组（P＜0.05）。结论：在常规治疗基础上联合富马酸比索洛尔治疗老年慢性心力衰竭的临床效果显著,其可有效改善患者心功能及运动耐力,值得推荐至临床广泛应用。     

八段锦联合心脏运动康复对急性心肌梗死急诊PCI术后患者心功能、运动耐力和生活质量的影响

摘要 目的：观察八段锦联合心脏运动康复对急性心肌梗死（AMI）急诊经皮冠状动脉介入术（PCI）后患者心功能、运动耐力和生活质量的影响。方法：选择2019年6月~2021年6月期间我院收治的AMI急诊PCI术后患者100例,根据随机数字表法分为对照组（心脏运动康复干预,50例）和观察组（八段锦联合心脏运动康复干预,50例）,观察两组患者心功能、运动耐力及生活质量改善情况,对比两组心脏不良事件发生率。结果：干预后,两组左心室射血分数（LVEF）较干预前升高,且观察组高于对照组（P<0.05）。干预后,两组左室舒张末期内径（LVDD）、左室收缩末期内径（LVDS）、B型脑利钠肽（BNP）较干预前下降,且观察组低于对照组（P<0.05）。干预后,两组运动持续时间（ED）、峰值摄氧量（VO₂peak）及无氧阈值（AT）较干预前升高,且观察组高于对照组（P<0.05）。干预后,两组健康调查简表（SF-36）各维度评分较干预前升高,且观察组高于对照组（P<0.05）。观察组的心脏不良事件发生率低于对照组（P<0.05）。结论：八段锦联合心脏运动康复用于AMI急诊PCI患者的术后干预中,可促进心功能恢复,改善患者的运动耐力及生活质量,同时还可降低心脏不良事件发生率。     

The kinetics of highly sensitive cardiac troponin T release after prolonged treadmill exercise in adolescent and adult athletes

The nature and kinetics of postexercise cardiac troponin (cTn) appearance is poorly described and understood in most athlete populations. We compared the kinetics of high-sensitivity cTn T (hs-cTnT) after endurance running in training-matched adolescents and adults. Thirteen male adolescent (mean age: 14.1 ± 1.1 yr) and 13 male adult (24.0 ± 3.6 yr) runners performed a 90-min constant-load treadmill run at 95% of ventilatory threshold. Serum hs-cTnT levels were assessed preexercise, immediately postexercise, and at 1, 2, 3, 4, 5, 6, and 24 h postexercise. Serum NH(2)-terminal pro-brain natriuretic peptide (NT-pro-BNP) levels were recorded preexercise and 3, 6, and 24 h postexercise. Left ventricular function was assessed preexercise, immediately postexercise, and 6 h postexercise. Peak hs-cTnT occurred at 3-4 h postexercise in all subjects, but was substantially higher (P < 0.05) in adolescents [median (range): 211.0 (11.2-794.5) ng/l] compared with adults [median (range): 19.1 (9.7-305.6) ng/l]. Peak hs-cTnT was followed by a rapid decrease in both groups, although adolescent data had not returned to baseline at 24 h. Substantial interindividual variability was noted in peak hs-cTnT, especially in the adolescents. NT-pro-BNP was significantly elevated postexercise in both adults and adolescents and remained above baseline at 24 h in both groups. In both groups, left ventricular ejection fraction and the ratio of early-to-atrial peak Doppler flow velocities were significantly decreased immediately postexercise. Peak hs-cTnT was not related to changes in ejection fraction, ratio of early-to-atrial peak Doppler flow velocities, or NT-pro-BNP. The present data suggest that postexercise hs-cTnT elevation 1) occurred in all runners, 2) peaked 3-4 h postexercise, and 3) the peak hs-cTnT concentration after prolonged exercise was higher in adolescents than adults.     

Development of a Novel Heart Failure Risk Tool: The Barcelona Bio-Heart Failure Risk Calculator (BCN Bio-HF Calculator)

Background

A combination of clinical and routine laboratory data with biomarkers reflecting different pathophysiological pathways may help to refine risk stratification in heart failure (HF). A novel calculator (BCN Bio-HF calculator) incorporating N-terminal pro B-type natriuretic peptide (NT-proBNP, a marker of myocardial stretch), high-sensitivity cardiac troponin T (hs-cTnT, a marker of myocyte injury), and high-sensitivity soluble ST2 (ST2), (reflective of myocardial fibrosis and remodeling) was developed.

Methods

Model performance was evaluated using discrimination, calibration, and reclassification tools for 1-, 2-, and 3-year mortality. Ten-fold cross-validation with 1000 bootstrapping was used.

Results

The BCN Bio-HF calculator was derived from 864 consecutive outpatients (72% men) with mean age 68.2±12 years (73%/27% New York Heart Association (NYHA) class I-II/III-IV, LVEF 36%, ischemic etiology 52.2%) and followed for a median of 3.4 years (305 deaths). After an initial evaluation of 23 variables, eight independent models were developed. The variables included in these models were age, sex, NYHA functional class, left ventricular ejection fraction, serum sodium, estimated glomerular filtration rate, hemoglobin, loop diuretic dose, β-blocker, Angiotensin converting enzyme inhibitor/Angiotensin-2 receptor blocker and statin treatments, and hs-cTnT, ST2, and NT-proBNP levels. The calculator may run with the availability of none, one, two, or the three biomarkers. The calculated risk of death was significantly changed by additive biomarker data. The average C-statistic in cross-validation analysis was 0.79.

Conclusions

A new HF risk-calculator that incorporates available biomarkers reflecting different pathophysiological pathways better allowed individual prediction of death at 1, 2, and 3 years.     

左西孟旦和米力农治疗难治性心力衰竭的疗效比较及对血清NT-proBNP、ET-1水平的影响

目的:观察和比较左西孟旦(LEV)与米力农(MIL)治疗难治性心力衰竭(RHF)的临床效果及对患者血清N末端B型利钠肽原(NT-proBNP)、内皮素(ET)-1水平的影响。方法:选取我院2015年1月~2017年4月收治的102例RHF患者,采取随机数字表法均分为两组。MIL组给予MIL治疗,LEV组予以LEV治疗。比较两组的临床疗效,治疗前后超声心动图指标[左室射血分数(LVEF)、二尖瓣舒张早期/舒张晚期峰值流速(E/A)、左室舒张末期内径(LVIDd)]、血清NT-proBNP、ET-1水平的变化及不良反应的发生情况。结果:治疗7 d后,LEV组总有效率较MIL组明显升高(P0.05)。与治疗前对比,两组治疗7 d后LVEF、E/A值均显著上升(P0.01),LVIDd值均显著下降(P0.01),且LEV组LVEF、E/A值均显著高于MIL组,LVIDd值均显著低于MIL组(P0.01)。两组治疗7 d后血清NT-proBNP、ET-1水平较治疗前均显著降低(P0.01),且LEV组血清NT-proBNP、ET-1水平均明显低于MIL组(P0.01)。LEV组不良反应的发生率较MIL组明显降低(P0.05)。结论:与米力农相比,左西孟旦治疗难治性心力衰竭能更有效缓解或消除患者症状体征、抑制心室重构、改善心功能,且安全性更高,可能与其显著降低血清NT-proBNP、ET-1水平有关。     

Plasma High Sensitivity Troponin T Levels in Adult Survivors of Childhood Leukaemias: Determinants and Associations with Cardiac Function

Background

We sought to quantify plasma high sensitivity cardiac troponin (hs-cTnT) levels, their determinants, and their associations with left ventricular (LV) myocardial deformation in adult survivors of childhood acute leukaemias.

Methods and Results

One hundred adult survivors (57 males) of childhood acute leukaemias, aged 24.1±4.2 years, and 42 age-matched controls (26 males) were studied. Plasma cTnT was determined using a highly sensitive assay. Genotyping of NAD(P)H oxidase and multidrug resistance protein polymorphisms was performed. Left ventricular function was assessed by conventional, three-dimensional, and speckle tracking echocardiography. The medians (interquartile range) of hs-cTnT in male and female survivors were 4.9 (4.2 to 7.2) ng/L and 1.0 (1.0 to 3.5) ng/L, respectively. Nineteen survivors (13 males, 6 females) (19%) had elevated hs-cTnT (>95^th centile of controls). Compared to those without elevated hs-TnT levels, these subjects had received larger cumulative anthracycline dose and were more likely to have leukaemic relapse, stem cell transplant, and cardiac irradiation. Their LV systolic and early diastolic myocardial velocities, isovolumic acceleration, and systolic longitudinal strain rate were significantly lower. Survivors having CT/TT at CYBA rs4673 had higher hs-cTnT levels than those with CC genotype. Functionally, increased hs-cTnT levels were associated with worse LV longitudinal systolic strain and systolic and diastolic strain rates.

Conclusions

Increased hs-cTnT levels occur in a significant proportion of adult survivors of childhood acute leukaemias and are associated with larger cumulative anthracycline dose received, history of leukaemic relapse, stem cell transplant, and cardiac irradiation, genetic variants in free radical metabolism, and worse LV myocardial deformation.