BACKGROUND:Serum troponins and CK-MB (creatine kinase-MB) are readily detectable and reliable cardiac-specific biomarkers of subclinical myocardial injury. This study explores the roles of cTnI (cardiac troponin I) and CK-MB in hypertrophic cardiomyopathy (HCM).METHODS:This study included 1045 patients with HCM who had baseline cTnI and CK-MB measurements at Fuwai Hospital between 1999 and 2019. Patients were excluded if they had undergone percutaneous coronary intervention or coronary artery bypass grafting, or had renal failure. Five end points were studied: all-cause death, cardiovascular death, noncardiovascular death, sudden cardiac death, and other cardiovascular death. Cox regression was used to assess the associations of cTnI and CK-MB levels with outcomes.RESULTS:Nine hundred seventy patients with available follow-up data were finally analyzed (mean age, 49.3 years; 36.4% female). During the median 4.3-year follow-up period, 87 patients reached the end points. Higher cTnI (per 0.05 ng/mL increase) and CK-MB (per 1 IU/L increase) levels were associated with increased risks of all-cause death (cTnI: adjusted hazard ratio [HR], 1.038, P<0.001; CK-MB: adjusted HR, 1.021, P=0.004), cardiovascular death (cTnI: adjusted HR, 1.040, P<0.001; CK-MB: adjusted HR, 1.025, P=0.006), and sudden cardiac death (cTnI: adjusted HR, 1.045, P<0.001; CK-MB: adjusted HR, 1.032, P=0.001). Patients with elevated levels of both cTnI and CK-MB had worse prognoses than patients with an elevated level of either biomarker alone and patients who did not have an elevated level of either biomarker. Addition of the binary indicator elevation of both cTnI and CK-MB significantly improved the discrimination and reclassification abilities of the standard HCM Risk- sudden cardiac death model (C statistics: P=0.002; net reclassification improvement, 0.652; integrated discrimination improvement, 0.064).CONCLUSIONS:Comprehensive evaluations of biomarkers of myocardial injury, cTnI and CK-MB, have considerable value for predicting adverse outcomes among patients with HCM. Routine cTnI and CK-MB assessments may help to guide implantable cardioverter defibrillator implantation for primary prevention in HCM.

中文翻译：

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心肌损伤生物标志物在预测肥厚型心肌病不良后果中的作用

背景：血清肌钙蛋白和 CK-MB（肌酸激酶-MB）是亚临床心肌损伤的易于检测且可靠的心脏特异性生物标志物。本研究探讨了 cTnI（心肌肌钙蛋白 I）和 CK-MB 在肥厚型心肌病 (HCM) 中的作用。 方法：本研究纳入了 1999 年至 2019 年间在阜外医院进行基线 cTnI 和 CK-MB 测量的 1045 名 HCM 患者。如果他们接受过经皮冠状动脉介入治疗或冠状动脉旁路移植术，或患有肾功能衰竭，则被排除。研究了五个终点：全因死亡、心血管死亡、非心血管死亡、心源性猝死和其他心血管死亡。Cox 回归用于评估 cTnI 和 CK-MB 水平与结果的关联。 结果：最终对 970 名具有可用随访数据的患者进行了分析（平均年龄，49.3 岁；36.4% 为女性）。在中位 4.3 年的随访期内，87 名患者达到了终点。较高的 cTnI（每增加 0.05 ng/mL）和 CK-MB（每增加 1 IU/L）水平与全因死亡风险增加相关（cTnI：调整后的风险比 [HR]，1.038，P < 0.001；CK -MB：调整后的 HR，1.021，P = 0.004）、心血管死亡（cTnI：调整后的 HR，1.040，P <0.001；CK-MB：调整后的 HR，1.025，P = 0.006）和心源性猝死（cTnI：调整后的 HR） ，1.045，P <0.001；CK-MB：调整后的 HR，1.032，P =0.001）。cTnI 和 CK-MB 水平同时升高的患者的预后比任一生物标志物单独升高的患者和任一生物标志物水平均不升高的患者预后更差。添加cTnI和CK-MB二元指标升高显着提高了标准HCM风险-心源性猝死模型的判别和重分类能力（C统计：P =0.002；净重分类改进，0.652；综合判别改进，0.064）结论：心肌损伤生物标志物 cTnI 和 CK-MB 的综合评估对于预测 HCM 患者的不良结局具有相当大的价值。常规 cTnI 和 CK-MB 评估可能有助于指导植入式心律转复除颤器植入，以实现 HCM 的一级预防。