背景:心肌肌钙蛋白(cTns)和炎症生物标志物在心力衰竭(HF)中升高并预测心血管风险。这些生物标志物是否与室性心律失常(VAs)的风险相关尚不清楚。
目的:本研究旨在评估cTnT是否,生长分化因子15(GDF-15),白细胞介素-6(IL-6),C反应蛋白(CRP)浓度与VA相关。
方法:在前瞻性中,植入式心律转复除颤器治疗患者的观察性研究,cTnT,在基线和1.4±0.5年后测量GDF-15,IL-6和CRP,并与植入式心脏复律除颤器检测到的事件VA相关,HF住院,和死亡率。
结果:本研究纳入489例患者,年龄66±12岁,83%为男性。包含时cTnT的中值浓度为15(Q1-Q3:9-25)ng/L,更高的浓度与更高的年龄有关,男性,糖尿病,冠状动脉疾病,和HF。在3.1±0.7年的随访期间,137例患者(28%)≥1VA。cTnT浓度与VA风险增加相关(每对数单位,HR:1.63;95%CI:1.31-2.01;P<0.001),也在调整年龄后,性别,身体质量指数,冠状动脉疾病,HF,肾功能,左心室射血分数(P<0.001)。GDF-15、IL-6和CRP浓度与VA事件无关,但所有患者(包括cTnT)均与HF住院率和死亡率相关.cTnT的变化,从基线到1.4年的GDF-15,IL-6和CRP与随后的VA无关。
结论:更高浓度的cTnT,GDF-15、IL-6和CRP与HF住院和死亡相关,但只有cTnT预测事件VA。这些发现表明,心肌损伤而不是炎症可能在VA和心源性猝死中起病理生理作用。
BACKGROUND: Cardiac troponins (cTns) and biomarkers of inflammation are elevated in heart failure (HF) and predict cardiovascular risk. Whether these biomarkers associate with risk of ventricular arrhythmias (VAs) is unclear.
OBJECTIVE: This study sought to assess whether cTnT, growth differentiation factor 15 (GDF-15), interleukin-6 (IL-6), and C-reactive protein (CRP) concentrations are associated with incident VA.
METHODS: In a prospective, observational study of patients treated with implantable cardioverter-defibrillator, cTnT, GDF-15, IL-6, and CRP were measured at baseline and after 1.4 ± 0.5 years and were associated with implantable cardioverter-defibrillator-detected incident VA, HF hospitalizations, and mortality.
RESULTS: This study included 489 patients aged 66 ± 12 years and 83% were men. Median concentrations of cTnT were 15 (Q1-Q3: 9-25) ng/L at inclusion, and higher concentrations were associated with higher age, male sex, diabetes mellitus, coronary artery disease, and HF. During 3.1 ± 0.7 years of follow-up, 137 patients (28%) had ≥1 VA. cTnT concentrations were associated with an increased VA risk (per log-unit, HR: 1.63; 95% CI: 1.31-2.01; P < 0.001), also after adjustment for age, sex, body mass index, coronary artery disease, HF, renal function, and left ventricular ejection fraction (P < 0.001). GDF-15, IL-6, and CRP concentrations were not associated with incident VA, but all (including cTnT) were associated with HF hospitalization and mortality. Changes in cTnT, GDF-15, IL-6, and CRP from baseline to 1.4 years were not associated with subsequent VA.
CONCLUSIONS: Higher concentrations of cTnT, GDF-15, IL-6, and CRP associate with HF hospitalization and death, but only cTnT predict incident VA. These findings suggest that myocardial injury rather than inflammation may play a pathophysiological role in VA and sudden cardiac death.