未经授权:高灵敏度肌钙蛋白T(hsTnT),心肌细胞超负荷和损伤的生物标志物,严重主动脉瓣狭窄(AS)的主动脉瓣置换术(AVR)和死亡率。然而,在无症状AS患者中,其预后价值尚不清楚.我们旨在调查hsTnT水平>14pg/mL(高于正常第99百分位数的上限)是否与超声心动图AS严重程度相关,随后的AVR,缺血性冠状动脉事件(ICE),无症状的非重度AS患者的死亡率。
UNASSIGNED:在对多中心的事后子分析中,随机化,双盲,安慰剂对照SEAS试验(ClinicalTrials.gov,NCT00092677),我们纳入了轻度至中度-重度AS的无症状患者.我们确定了基线和1年hsTnT浓度,并检查了基线水平与主要复合终点风险之间的关系,定义为全因死亡率的第一个事件,孤立的AVR(无冠状动脉旁路移植术(CABG)),或冰。多变量回归和竞争风险分析检查了hsTnT水平>14pg/mL与主要终点的临床相关性和5年风险的关联。
UNASSIGNED:在2003年1月6日至2004年3月4日之间,共有1873名患者参加了SEAS试验,1739例患者被纳入本事后亚分析.患者的平均年龄(SD)为67.5(9.7)岁,61.0%(1061)是男性,17.4%(302)患有中重度AS,26.0%(453)的hsTnT水平>14pg/mL。从基线到1年的hsTnT中位数差异为0.8pg/mL(IQR,-0.4至2.3)。在调整线性回归中,log(hsTnT)与超声心动图AS严重程度无相关性(p=0.36).在多变量Cox回归中,hsTnT水平>14pg/mL与hsTnT≤14pg/mL与主要复合终点的风险增加相关(HR,1.41;95%CI,1.18-1.70;p=0.0002)。在主要终点的第一个单独组成部分的竞争风险模型中,hsTnT水平>14pg/mL与ICE风险相关(HR1.71;95%CI,1.23-2.38;p=0.0013),但没有孤立的AVR(p=0.064)或全因死亡率(p=0.49)作为第一个事件。
UNASSIGNED:在4例无症状轻度至中度AS的非缺血性患者中,有3例的hsTnT水平在参考范围内(≤14pg/mL),并且在1年随访期间保持稳定,无论AS严重程度如何。hsTnT水平>14pg/mL主要与随后的ICE相关,这表明hsTnT浓度主要是亚临床冠状动脉粥样硬化疾病的风险标志物。
未经批准:默克公司,Inc.,先灵-雅公司,InterregIVA计划,罗氏诊断有限公司还有Gangstedfonden.教授提供的开放获取出版费资金。OlavW.Nielsen和心内科,Bispebjerg大学医院,丹麦。
UNASSIGNED: High-sensitivity Troponin T (hsTnT), a biomarker of cardiomyocyte overload and injury, relates to aortic valve replacement (AVR) and mortality in severe aortic stenosis (AS). However, its prognostic value remains unknown in asymptomatic patients with AS. We aimed to investigate if an hsTnT level >14 pg/mL (above upper limit of normal 99th percentile) is associated with echocardiographic AS-severity, subsequent AVR, ischaemic coronary events (ICE), and mortality in asymptomatic patients with non-severe AS.
UNASSIGNED: In this post-hoc sub-analysis of the multicentre, randomised, double-blind, placebo-controlled SEAS
trial (ClinicalTrials.gov, NCT00092677), we included asymptomatic patients with mild to moderate-severe AS. We ascertained baseline and 1-year hsTnT concentrations and examined the association between baseline levels and the risk of the primary composite endpoint, defined as the first event of all-cause mortality, isolated AVR (without coronary artery bypass grafting (CABG)), or ICE. Multivariable regressions and competing risk analyses examined associations of hsTnT level >14 pg/mL with clinical correlates and 5-year risk of the primary endpoint.
UNASSIGNED: Between January 6, 2003, and March 4, 2004, a total of 1873 patients were enrolled in the SEAS
trial, and 1739 patients were included in this post-hoc sub-analysis. Patients had a mean (SD) age of 67.5 (9.7) years, 61.0% (1061) were men, 17.4% (302) had moderate-severe AS, and 26.0% (453) had hsTnT level >14 pg/mL. The median hsTnT difference from baseline to 1-year was 0.8 pg/mL (IQR, -0.4 to 2.3). In adjusted linear regression, log(hsTnT) did not correlate with echocardiographic AS severity (p = 0.36). In multivariable Cox regression, a hsTnT level >14 pg/mL vs. hsTnT ≤14 pg/mL was associated with an increased risk of the primary composite endpoint (HR, 1.41; 95% CI, 1.18-1.70; p = 0.0002). In a competing risk model of first of the individual components of the primary endpoint, a hsTnT level >14 pg/mL was associated with ICE risk (HR 1.71; 95% CI, 1.23-2.38; p = 0.0013), but not with isolated AVR (p = 0.064) or all-cause mortality (p = 0.49) as the first event.
UNASSIGNED: hsTnT level is within the reference range (≤14 pg/mL) in 3 out of 4 non-ischaemic patients with asymptomatic mild-to-moderate AS and remains stable during a 1-year follow-up regardless of AS-severity. An hsTnT level >14 pg/mL was mainly associated with subsequent ICE, which suggest that hsTnT concentration is primarily a risk marker of subclinical coronary atherosclerotic disease.
UNASSIGNED: Merck & Co., Inc., the Schering-Plough Corporation, the Interreg IVA program, Roche Diagnostics Ltd., and Gangstedfonden. Open access publication fee funding provided by prof. Olav W. Nielsen and Department of Cardiology, Bispebjerg University Hospital, Denmark.