用心肌肌钙蛋白判断糖尿病患者和代谢综合征小鼠模型的亚临床心衰

IF 1.8 Q3 MEDICAL LABORATORY TECHNOLOGY Journal of Applied Laboratory Medicine Pub Date : 2024-11-04 DOI:10.1093/jalm/jfae091
Hannah M Brown, Nicholas C Spies, Wentong Jia, John Moley, Sydney Lawless, Brittany Roemmich, Jonathan R Brestoff, Mark A Zaydman, Christopher W Farnsworth
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引用次数: 0

摘要

背景:心血管疾病、肾脏健康和代谢疾病(CKM)综合征与严重的发病率和死亡率有关,尤其是充血性心力衰竭(CHF)。指南建议通过测量心肌肌钙蛋白(cTn)来识别糖尿病/CKM 患者的亚临床心力衰竭(HF)。方法:使用雅培高灵敏度 (hs)-cTnI 检测法对门诊患者的血红蛋白 A1c (Hb A1c) 进行评估,并将其与心脏合并症/诊断、人口统计学和估计肾小球滤过率 (eGFR) 联系起来。CKM分期指南中使用的风险阈值为女性>10 ng/L,男性>12 ng/L。在高脂饮食诱导的肥胖和糖尿病小鼠模型中对 hs-cTnI 进行了评估:在 1304 名患者中,8.0% 的女性和 15.7% 的男性 cTnI 浓度高于风险阈值。31名女性(4.2%)和23名男性(4.1%)的cTnI超过了性别特异性的99%参考上限。hs-cTnI与血红蛋白A1c(R = 0.2)和eGFR(R = -0.5)之间存在相关性,hs-cTnI浓度在A1C为8%时呈阶梯式上升(2.8,2.2-4.3)。雄性(P < 0.001)、eGFR(P < 0.001)和 CHF(P = 0.004)预示着 hs-cTnI 的升高。肥胖和糖尿病小鼠的hs-cTnI升高(7.3纳克/升,4.2-10.4),而饲料喂养小鼠的hs-cTnI升高(2.6纳克/升,1.3-3.8):结论:根据hs-cTnI测量结果,很大一部分门诊糖尿病患者符合亚临床心房颤动的标准。葡萄糖控制与 cTnI 升高密切相关,这一发现在代谢综合征小鼠模型中得到了证实。
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Cardiac Troponin to Adjudicate Subclinical Heart Failure in Diabetic Patients and a Murine Model of Metabolic Syndrome.

Background: Cardiovascular disease, kidney health, and metabolic disease (CKM) syndrome is associated with significant morbidity and mortality, particularly from congestive heart failure (CHF). Guidelines recommend measurement of cardiac troponin (cTn) to identify subclinical heart failure (HF) in diabetics/CKM. However, appropriate thresholds and the impact from routine screening have not been elucidated.

Methods: cTnI was assessed using the Abbott high sensitivity (hs)-cTnI assay in outpatients with physician-ordered hemoglobin A1c (Hb A1c) and associated with cardiac comorbidities/diagnoses, demographics, and estimated glomerular filtration rate (eGFR). Risk thresholds used in CKM staging guidelines of >10 and >12 ng/L for females and males, respectively, were used. Multivariate logistic regression was applied. hs-cTnI was assessed in a high-fat-diet induced murine model of obesity and diabetes.

Results: Of 1304 patients, 8.0% females and 15.7% males had cTnI concentrations above the risk thresholds. Thirty-one (4.2%) females and 23 (4.1%) males had cTnI above the sex-specific 99% upper reference limit. A correlation between hs-cTnI and Hb A1c (R = 0.2) and eGFR (R = -0.5) was observed. hs-cTnI concentrations increased stepwise based on A1C of <5.7% (median = 1.5, IQR:1.3-1.8), 5.7%-6.4% (2.1, 2.0-2.4), 6.5%-8.0% (2.8, 2.5-3.2), and >8% (2.8, 2.2-4.3). Male sex (P < 0.001), eGFR (P < 0.001), and CHF (P = 0.004) predicted elevated hs-cTnI. Obese and diabetic mice had increased hs-cTnI (7.3 ng/L, 4.2-10.4) relative to chow-fed mice (2.6 ng/L, 1.3-3.8).

Conclusion: A high proportion of outpatients with diabetes meet criteria for subclinical HF using hs-cTnI measurements. Glucose control is independently associated with elevated cTnI, a finding replicated in a murine model of metabolic syndrome.

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来源期刊
Journal of Applied Laboratory Medicine
Journal of Applied Laboratory Medicine MEDICAL LABORATORY TECHNOLOGY-
CiteScore
3.70
自引率
5.00%
发文量
137
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