发布日期：2010 年 12 月
英文标题：Association of serial measures of cardiac troponin T using a sensitive assay with incident heart failure and cardiovascular mortality in older adults.
作者：deFilippi CR, de Lemos JA, Christenson RH, Gottdiener JS, Kop WJ, Zhan M, Seliger SL.
出处：JAMA. 2010 Dec 8;304(22):2494-502.
内容介绍：该研究揭示了对于不伴有已知心衰的老年患者，通过高敏感性方法测量的基线 cTnT 水平和 cTnT 水平变化与心衰事件和心血管死亡显著相关，即基线以及 2-3 年内肌钙蛋白水平变化状况均是发生心衰以及心血管事件死亡事件的预示因子，丰富了高敏肌钙蛋白水平的临床意义。采用高敏肌钙蛋白进行危险分层，可有助于心血管疾病的防治，其确切的防治效果还需大型的 RCT 予以证明。
摘要展示：
CONTEXT: 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.
OBJECTIVES: To determine if cardiac troponin T (cTnT) measured by a highly sensitive assaywould be detectable in the majority of community-dwelling older adults, and if serial measureswere associated with risk of HF hospitalization and cardiovascular death.
DESIGN, SETTING, AND PARTICIPANTS: A longitudinal nationwide cohort study (CardiovascularHealth 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).
MAIN OUTCOME MEASURES: New-onset HF and cardiovascular death were examined through June 2008 with respect to cTnT concentrations, accounting for clinical risk predictors.
RESULTS: 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 1103cardiovascular 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.
CONCLUSION: 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 incidentHF and cardiovascular death.
