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首页> 外文学位 >Troponin and Left Ventricular Function After Myocardial Infarction.
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Troponin and Left Ventricular Function After Myocardial Infarction.

机译：心肌梗塞后肌钙蛋白和左心室功能。

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摘要

In the first part of this thesis we compared patients with MI who met only c-TnT criteria to patients with MI who met CK-MB criteria, in a population-based cohort from Olmsted County, MN. Our aims were to: ;We accomplished this by prospective identification of 835 MIs in the community using standardized criteria including cardiac pain, ECG and biomarkers, from November, 2002 to May, 2006. We prospectively measured troponin and CK-MB in all; each patient was classified according to the criteria met. We performed echocardiograms (median of 1 day post-MI) in 482 patients (age 68 +/- 15 years; 45% women); 363 patients met CK-MB criteria while 119 met c-TnT criteria. The latter group had lower wall motion score index (1.3 +/- 0.4 vs 1.5 +/- 0.5 for CK-MB; p 0.01). Diastolic dysfunction was similar for the two groups. After one year of follow up, 142 patients developed post-MI HF. Patients meeting c-TnT criteria had a lower risk of HF after adjustment for age, sex and comorbidity (HR 0.56, 95% CI 0.37, 0.85, p0.01), which persisted after further adjustments for systolic or diastolic function. In the community, the prospective application of the new MI definition identified patients meeting only c-TnT criteria who had better systolic function than cases meeting CK-MB criteria. Such MI cases have a lower risk of subsequent HF. These findings are relevant for risk stratification in clinical practice.;In the second part of this thesis, the aim (;We evaluated a subset of patients with first MI prospectively enrolled in a community-based cohort of MI in Olmsted County, MN. Serial c-TnT levels were obtained at presentation, 12 hours, 1 day, 2 days, and 3 days after onset of pain. Peak c-TnT was the maximum c-TnT value. The patient group was obtained by prospective recruitment of 121 patients (age 61 +/- 13; 31% women) with MI who underwent gated SPECT-MPI at a median (25%; 75%) of 10 (5; 15) days post-MI. The median infarct size was 1% (0%; 11%) and median gated LVEF was 54% (47%; 60%). 59 patients (49% of the population) had no measurable infarction by SPECT-MPI. The independent predictors for measurable SPECT-MPI infarct size included c-TnT at days 1, 2, 3 and peak c-TnT, but not at presentation or 12 hours. Early values of c-TnT (at presentation and 12 hours) were not independent predictors of measurable SPECT-MPI MI size. Independent predictors of measurable SPECT-MPI infarct size included later c-TnT at days 1, 2, 3 and peak c-TnT. ROC analysis demonstrated a cut-off peak c-TnT of 1.5 ng/mL for detection of measurable infarct size.;The data from this study indicated that SPECT-MPI did not detect measurable infarct in nearly half of the patients with MI diagnosed by c-TnT criteria. The independent predictors for measurable SPECT-MPI infarct size included c-TnT at days 1, 2, 3 and peak c-TnT; ROC analysis demonstrated a cut-off peak c-TnT of 1.5 ng/mL for detection of measurable infarct size, using the third generation c-TnT assay. Finally, infarct size and peak c-TnT were independent predictors for major cardiac events at follow up.;In this thesis, the overall conclusion is that patients diagnosed with AMI by the new diagnostic criteria defined by c-Tn elevation have better left ventricular function, smaller infarct size and less adverse outcomes at follow-up.
机译：在本论文的第一部分中，我们在以明尼苏达州奥尔姆斯特德县为基础的人群研究中比较了仅符合c-TnT标准的MI患者和符合CK-MB标准的MI患者。我们的目标是：从2002年11月至2006年5月，通过使用标准化标准（包括心脏疼痛，ECG和生物标志物）对社区中的835个MI进行前瞻性鉴定，从而完成了这一目标。根据符合的标准对每位患者进行分类。我们对482例患者（年龄68 +/- 15岁； 45％的女性）进行了超声心动图检查（MI后1天中位数）； 363例患者符合CK-MB标准，而119例符合c-TnT标准。后者的壁运动评分指数较低（CK-MB为1.3 +/- 0.4，而CK-MB为1.5 +/- 0.5； p <0.01）。两组的舒张功能障碍相似。经过一年的随访，有142例患者出现了MI后心衰。调整年龄，性别和合并症后，符合c-TnT标准的患者发生HF的风险较低（HR 0.56，95％CI 0.37，0.85，p <0.01），在进一步调整收缩或舒张功能后仍然存在。在社区中，新MI定义的前瞻性应用表明，仅满足c-TnT标准的患者的收缩功能要比满足CK-MB标准的患者更好。此类MI病例发生随后的HF的风险较低。这些发现与临床实践中的风险分层有关。在本论文的第二部分中，我们的目标是；（我们评估了一部分前瞻性入选于明尼苏达州奥姆斯特德县基于社区的MI患者的一部分MI。 c-TnT水平在发作时，疼痛发作后<12小时，1天，2天和3天获得，峰值c-TnT为最大c-TnT值，该患者组通过前瞻性募集121位患者而获得（61 +/- 13岁； 31％的女性）患有MI的患者在MI后10（5; 15）天的中位（25％; 75％）接受门控SPECT-MPI。中度梗死面积为1％（ 0％； 11％）和门控LVEF的中位数为54％（47％； 60％）； 59例患者（占总人口的49％）没有通过SPECT-MPI可测量的梗塞；包括可测量的SPECT-MPI梗塞大小的独立预测因子第1、2、3天和c-TnT高峰时的c-TnT，但未在出现或<12小时时出现，但早期c-TnT值（出现在和<12小时时）不是measu的独立预测因子可靠的SPECT-MPI MI大小。可测量SPECT-MPI梗死面积的独立预测因素包括第1、2、3天的较晚c-TnT和峰值c-TnT。 ROC分析显示，用于检测可测量的梗死面积的临界峰c-TnT为1.5 ng / mL。 -TnT标准。可测量的SPECT-MPI梗死面积的独立预测因子包括第1、2、3天的c-TnT和峰值c-TnT。 ROC分析表明，使用第三代c-TnT测定法可检测出梗死面积的临界峰c-TnT为1.5 ng / mL。最后，梗塞面积和c-TnT峰值是随访中主要心脏事件的独立预测因子。；本论文的总体结论是，根据c-Tn升高定义的新诊断标准诊断为AMI的患者左心室功能更好，较小的梗塞面积和较少的不良预后。

著录项

  • 作者

    Olson, Adelaide Maria Martins Arruda.;

  • 作者单位

    College of Medicine - Mayo Clinic.;

  • 授予单位 College of Medicine - Mayo Clinic.;
  • 学科 Health Sciences Medicine and Surgery.;Health Sciences Epidemiology.
  • 学位 M.S.
  • 年度 2011
  • 页码 49 p.
  • 总页数 49
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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