• 作者：Carmen Muñ ; oz-Esparza^a ; Iris P. Garrido^a ; Rosa Blanco^b ; Teresa Casas^c ; Cristina Gonzá ; lez-Cá ; novas^a ; Francisco Pastor-Pé ; rez^a ; Pablo Peñ ; afiel^a ; Alfredo Minguela^b ; Mariano Valdé ; s^a ; ^d ; Domingo A. Pascual-Figal^a ; ^d ; ^{dapascual@servicam.com}
• 关键词：Trasplante ; Rechazo ; Troponina
• 刊名：Revista Espa帽ola de Cardiolog铆a
• 出版年：2011
• 期刊代码：pca308_03008932
• 类别：med
• 出版时间：December 2011
• 卷：64
• 期：12
• 页码：1109-1113
• 文件大小：254 K

Introduction and objectives

Detection of acute allograft rejection in heart transplant recipients by noninvasive methods is a challenge in the management of these patients. In this study, the usefulness of a new highly sensitive method for the measurement of troponin T is evaluated.

Methods

We designed a case-crossover study, in which each patient served as his or her own control, by selecting samples from treated acute rejection episodes (29 cases) and samples obtained immediately before and/or after rejection (38 controls). The highly sensitive troponin T was measured by a new pre-commercial test (Elecsys Troponin T HS).

Results

In all samples, highly sensitive troponin T was detectable, with a median of 0.068 ng/L (IQR, 0.030-0.300 ng/L). The levels correlated with right atrial pressure (r=0.37; P=.002), N-terminal pro-brain natriuretic peptide concentration (r=0.67; P<.001), and time since transplantation (r=鈥?.81; P<.001). The highly sensitive troponin T concentrations were higher in patients with rejection (0.155 ng/mL vs 0.047 ng/mL; P=.006). In the receiver operating characteristic analysis, the area under the curve was 0.67 (95%confidence interval, 0.53-0.77) and the best cutoff was 0.035 ng/mL, which was associated with rejection (odds ratio=3.7; 95%confidence interval, 1.2-11.9; P=.02). By restricting the analysis to the first 2 months, the area under the curve increased to 0.86 (95%confidence interval 0.66-0.97), with an optimal cutoff of 1.10 ng/mL (S=58%[28%-85%]; E=100%[74%-100%]).

Conclusions

Troponin T was detectable in all samples when a new highly sensitive assay was used, and at higher concentrations in the presence of acute rejection; however, the usefulness of this test in patient management is limited to support for clinical or histological suspicion of rejection, especially in the early post-transplant period.

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