Am J Cardiol：hs-cTnT联合BNP可用于心肌纤维化检测

　　日本一项研究表明，在肥厚型心肌病患者中，高敏心脏肌钙蛋白T（hs-cTnT）和脑利钠肽（BNP）联合可用于检测心肌纤维化。论文于6月10日在线发表于《美国心脏病学杂志》（Am J Cardiol）。

　　此项研究共纳入53例肥厚型心肌病患者，其中23例患者伴有延迟钆增强。评估血清肌红蛋白、心肌肌球蛋白轻链I、hs-cTnT、肌酸激酶MB同工酶水平和血浆BNP水平与延迟钆增强的相关性。

　　结果显示，延迟钆增强患者的hs-cTnT和BNP水平高于无增强患者。hs-cTnT≥0.007 ng/ml或BNP≥70 pg/ml在检出延迟钆增强方面具有良好的诊断价值；两种生物标志物联用的敏感性和特异性分别为96%和90%。延迟钆增强的范围与BNP水平具有相关性(P <0.01)，但与hs-cTnT水平无关。在22个月随访期间，8例患者的延迟钆增强程度升高与hs-cTnT水平具有相关性（P = 0.02）。

Usefulness of High-Sensitivity Cardiac Troponin T and Brain Natriuretic Peptide as Biomarkers of Myocardial Fibrosis in Patients With Hypertrophic Cardiomyopathy
ABSTRACT
Myocardial fibrosis assessed by late gadolinium enhancement cardiac magnetic resonance imaging is associated with cardiovascular events in patients with hypertrophic cardiomyopathy (HC), but few data are available regarding the utility of biomarkers for detecting late gadolinium enhancement. The aim of this study was to examine serum levels of myoglobin, cardiac myosin light chain I, high-sensitivity cardiac troponin T (hs-cTnT), and creatine kinase-MB isoenzyme and plasma levels of brain natriuretic peptide (BNP) in relation to late gadolinium enhancement in 53 patients with HC. Levels of hs-cTnT and BNP were higher in 23 patients with late gadolinium enhancement than in 30 patients without it (p <0.01 for both). An hs-cTnT level ≥0.007 ng/ml or a BNP level ≥70 pg/ml had good diagnostic value for detecting late gadolinium enhancement, with sensitivity of 96% or specificity of 90% with the combination of these 2 biomarkers. The extent of late gadolinium enhancement was correlated with BNP level (p <0.01) but not with hs-cTnT level in 23 patients with HC with late gadolinium enhancement. The increase in the extent of late gadolinium enhancement was related to hs-cTnT level in 8 patients during 22 months of follow-up (p = 0.02). In conclusion, the combination of hs-cTnT and BNP is useful in detecting myocardial fibrosis in patients with HC. The findings of this study indicate that hs-cTnT is a direct marker of ongoing myocardial fibrosis and that BNP is a marker of left ventricular overload partially associated with myocardial fibrosis.