Expertos Invitados





TROPONINAS CARDIACAS NA AVALIAÇAO PROGNOSTICA E ESTRATIFICAÇAO DE RISCO NA INSUFICIENCIA CARDIACA

(especial para SIIC © Derechos reservados)
A insuficiência cardíaca é uma síndrome clínica, caracterizada por alta morbidade, mortalidade e diminuição da qualidade de vida. A utilização de biomarcadores de lesão miocárdica altamente sensíveis e específicos (troponinas cardíacas) tem demonstrado utilidade na avaliação prognóstica destes pacientes.
Autor:
Carlos henrique Del carlo
Columnista Experto de SIIC

Institución:
Universidade de São Paulo

Artículos publicados por Carlos henrique Del carlo
Recepción del artículo
15 de Agosto, 2012 		Aprobación
22 de Octubre, 2012
Primera edición
13 de Diciembre, 2012 		Segunda edición, ampliada y corregida
7 de Junio, 2021

TROPONINAS CARDIACAS NA AVALIAÇAO PROGNOSTICA E ESTRATIFICAÇAO DE RISCO NA INSUFICIENCIA CARDIACA

Resumen
Introdução: As troponinas cardíacas (T e I) foram detectadas na insuficiência cardíaca (IC), tanto na forma crônica avançada, quanto na descompensada, de etiologia isquêmica e não-isquêmica, estando associadas com mau prognóstico. O objetivo deste estudo foi analisar a prevalência das troponinas, mecanismos de liberação e seu valor prognóstico e na estratificação de risco dos pacientes com IC. Resultados: A prevalência das troponinas na IC tem variado amplamente, desde 6.2% até 83.9% (média: 40%), dependendo da sensibilidade do teste e da população estudada. Os mecanismos envolvidos na liberação das troponinas cardíacas na IC permanecem especulativos, mas parecem estar relacionados com os mecanismos de progressão da IC. A presença de lesão miocárdica subclínica, detectada pelas troponinas, é um marcador de mau prognóstico na IC. Diferentes estratégias de detecção das troponinas na IC: determinação única, grau de elevação pela faixa de valores, medida seriada e associação com outros biomarcadores, são formas simples e confiável para avaliação prognostica e estratificação de risco desses pacientes. Conclusão: A detecção das troponinas é um marcador de mau prognóstico na IC. A abordagem terapêutica para redução dos níveis de troponinas na IC abre novas perspectivas para o desenvolvimento de estratégias para prevenção da lesão celular na IC.

Palabras clave
biomarcadores, troponina cardíaca T, troponina cardíaca I, insuficiência cardíaca, prognóstico


Artículo completo
(castellano)
Extensión:  +/-6.42 páginas impresas en papel A4
Exclusivo para suscriptores/assinantes

Cardiac troponins in the prognostic evaluation and risk stratification of heart failure

Abstract
Introduction: Cardiac troponins (T and I) were detected in heart failure (HF), both in advanced chronic form, as in those of decompensated, ischemic and nonischemic etiology, and are associated with poor prognosis. The objective of this study was to analyze the prevalence of troponins, release mechanisms and their value in prognosis and risk stratification of patients with HF.
Results: The prevalence of troponins in HF has varied widely, from 6.2% to 83.9% (average: 40%), depending on the sensitivity of the test and the population studied. The mechanisms involved in the release of cardiac troponins in HF remain speculative, but seem to be related to the mechanisms of progression of HF. The presence of subclinical myocardial damage detected by troponins is a marker of poor prognosis in HF. Different strategies for the detection of troponins in HF: sole determination, the degree of elevation range, serial measurements and association with other biomarkers, are simple and reliable ways to assess prognostic and risk stratification of these patients.
Conclusion: The detection of troponins is a marker of poor prognosis in HF. The therapeutic approach to reducing levels of troponins in HF opens new perspectives for the development of strategies for prevention of cellular injury in heart failure.

Key words
biomarkers, prognosis, heart failure, cardiac troponin T, cardiac troponin I

Clasificación en siicsalud
Artículos originales > Expertos de Iberoamérica >
página   www.siicsalud.com/des/expertocompleto.php/

Especialidades
Principal: Cardiología, Diagnóstico por Laboratorio
Relacionadas: Bioquímica, Cuidados Intensivos, Geriatría, Medicina Interna



Comprar este artículo
Extensión: 6.42 páginas impresas en papel A4

file05.gif (1491 bytes) Artículos seleccionados para su compra



Enviar correspondencia a:
Carlos Henrique Del Carlo, Universidade de São Paulo Instituto do Coração Hospital das Clínicas da Faculdade de Medicina, CEP: 02020, Rua Marechal Hermes da Fonseca, 722 – apto 151, San Pablo, Brasil
Bibliografía del artículo
1. Bocchi EA, Marcondes-Braga FG, Ayub-Ferreira SM, e col. Sociedade Brasileira de Cardiologia. III Diretriz Brasileira de Insuficiência Cardíaca Crônica. Arq Bras Cardiol 93(1 supl. 1):1-71, 2009.
2. Bocchi EA, Guimarães G, Tarasoutshi F, Spina G, Mangini S, Bacal F. Cardiomyopathy, adult valve disease and heart failure in South America. Heart 95(3):181-9, 2009.
3. Biomarkers Definitions Working Group.. Biomarkers and surrogate endpoints: preferred definitions and conceptual framework. Clin Pharmacol Ther 69(3):89-95, 2001.
4. Katus HA, Remppis A, Looser S, Hallermeier K, Scheffold T, Kübler W. Enzyme linked immuno assay of cardiac troponin T for the detection of acute myocardial infarction in patients. J Mol Cell Cardiol 21(12):1349-53, 1989.
5. Kushner FG, Hand M, Smith SC Jr, e col. 2009 focused updates: ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction (updating the 2004 guideline and 2007 focused update) and ACC/AHA/SCAI guidelines on percutaneous coronary intervention (updating the 2005 guideline and 2007 focused update) a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 54(23):2205-41, 2009.
6. Wallace TW, Abdullah SM, Drazner MH, e col. Prevalence and determinants of troponin T elevation in the general population. Circulation 113(16):1958-65, 2006.
7. Missov E, Calzolari C. Elevated cardiac troponin I in some patients with severe congestive heart failure [abstract]. J Mol Cell Cardiol 27:A-405, 1995.
8. Missov E, Calzolari, Pau B. High circulating levels of cardiac troponin I in human congestive heart failure [abstract]. J Am Coll Cardiol 27(Suppl A):338A, 1996.
9. Missov E, Calzolari C, Pau B. Circulating cardiac troponin I in severe congestive heart failure. Circulation 96(9):2953-8, 1997.
10. Kociol RD, Pang OS, Gheorgiade M, Fonarow GC, O'Connor CM, Felker GM. Troponin elevation in in heart failure. J Am Coll Cardiol 56(14):1071-8, 2010.
11. Del Carlo CH, Pereira-Barretto AC, Cassaro-Strunz CM, Latorre MRDO, Ramire JAF. Serial measure of cardiac troponin T levels for prediction of clinical events in decompensated heart failure. J Card Fail 10(1):43-8, 2004.
12. Del Carlo CH, O'Connor CM. Cardiac troponins in congestive heart failure. Am Heart J 138(4 Pt 1):646-53, 1999.
13. Schrier RW, Abraham WT. Hormones and hemodynamics in heart failure. N Engl J Med 341(8):577-85, 1999.
14. Ricchiuti V, Zhang J, Apple FS. Cardiac troponin I and T alterations in hearts with severe left ventricular remodeling. Clin Chem 43(6 Pt 1):990-5, 1997.
15. Narula J, Haider N, Virmani R, e col. Apoptosis in myocytes in end-stage heart failure. N Engl J Med 335(16):1182-9, 1996.
16. Olivetti G, Abbi R, Quaini F, e col. Apoptosis in the failing human heart. N Engl J Med 336(16):1131-41, 1997.
17. Narula J, Haider N, Arbustini E, Chandrashekhar Y. Mechanisms of disease: apoptosis in heart failure--seeing hope in death. Nat Clin Pract Cardiovasc Med 3(12):681-8, 1996.
18. Colucci WS. Apoptosis in the heart. N Engl J Med 335(16):1224-6, 1996.
19. He J, Ogden LG, Bazzano LA, Vupputuri S, Loria C, Whelton PK. Risk factors for congestive heart failure in US men and women: NHANES I epidemiologic follow-up study. Arch Intern Med 161(7):996-1002, 2001.
20. Uretsky BF, Thygesen K, Armstrong PW, e col. Acute coronary findings at autopsy in heart failure patients with sudden death: results from the assessment of treatment with lisinopril and survival (ATLAS) trial. Circulation 102(6):611-6, 2000.
21. Fang ZY, Marwick TH. Vascular dysfunction and heart failure: epiphenomenon or etiologic agent? Am Heart J 143(3):383-90, 2002.
22. Conway RS, Natelson BH, Chen WH, Ting W. Enhanced coronary vasoconstriction in the Syrian myopathic hamster supports the microvascular spasm hypothesis. Cardiovasc Res 28(3):320-4, 1994.
23. Liu PP, Mak S, Stewart DJ. Potential role of the microvasculature in progression of heart failure. Am J Cardiol 19;84(4A):23L-26L, 1999.
24. Roura S, Bayes-Genis A. Vascular dysfunction in idiopathic dilated cardiomyopathy. Nat Rev Cardiol 6(9):590-8, 2009.
25. van den Heuvel AF, van Veldhuisen DJ, van der Wall EE, e col. Regional myocardial blood flow reserve impairment and metabolic changes suggesting myocardial ischemia in patients with idiopathic dilated cardiomyopathy. J Am Coll Cardiol 35(1):19-28, 2000.
26. Vogt M, Strauer BE. Systolic ventricular dysfunction and heart failure due to coronary microangiopathy in hypertensive heart disease. Am J Cardiol 76(13):48D-53D, 1995.
27. Logeart D, Beyne P, Cusson C, e col. Evidence of cardiac myolysis in severe nonischemic heart failure and the potential role of increased wall strain. Am Heart J 141(2):247-53, 2001.
28. Feng J, Schaus BJ, Fallavollita JA, Lee TC, Canty JM Jr. Preload induces troponin I degradation independently of myocardial ischemia. Circulation 103(16):2035-7, 2001.
29. Saravia SG, Haberland A, Bartel S, e col. Cardiac troponin T measured with a highly sensitive assay for diagnosis and monitoring of heart injury in chronic Chagas disease. Arch Pathol Lab Med 135(2):243-8, 2011.
30. Del Carlo CH, Pereira-Barretto AC, Cassaro-Strunz CM, Latorre Mdo R, Oliveira Junior MT, Ramires JA. Cardiac troponin T for risk stratification in decompensated chronic heart failure. Arq Bras Cardiol 92(5):372-80, 2009.
31. Oliveira MD, Alvares J, Moreira MC. Single cardiac troponin T measurement predicts risk for adverse outcome in decompensated heart failure. Arq Bras Cardiol 94(4):527-34, 2010.
32. Marin-Neto JA, Cunha-Neto E, Maciel BC, Simões MV. Pathogenesis of chronic Chagas heart disease. Circulation 115(9):1109-23, 2007.
33. Higuchi ML, Fukasawa S, De Brito T, Parzianello LC, Bellotti G, Ramires JA. Different microcirculatory and interstitial matrix patterns in idiopathic dilated cardiomyopathy and Chagas' disease: a three dimensional confocal microscopy study. Heart 82(3):279-85, 1999.
34. La Vecchia L, Mezzena G, Ometto R, e col. Detectable serum troponin I in patients with heart failure of nonmyocardial ischemic origin. Am J Cardiol 80(1):88-90, 1997.
35. Peacock WF 4th, De Marco T, Fonarow GC, Diercks D, Wynne J, Apple FS, Wu AH; ADHERE Investigators. Cardiac troponin and outcome in acute heart failure. N Engl J Med 358(20):2117-26, 2008.
36. You JJ, Austin PC, Alter DA, Ko DT, Tu JV. Relation between cardiac troponin I and mortality in acute decompensated heart failure. Am Heart J 153(4):462-70, 2007.
37. Latini R, Masson S, Anand IS, e col.; Val-HeFT Investigators. Prognostic value of very low plasma concentrations of troponin T in patients with stable chronic heart failure. Circulation 116(11):1242-9, 2007.
38. Miller WL, Hartman KA, Burritt MF, Grill DE, Jaffe AS. Profiles of serial changes in cardiac troponin T concentrations and outcome in ambulatory patients with chronic heart failure. J Am Coll Cardiol 54(18):1715-21, 2009.
39. Ishii J, Nomura M, Nakamura Y, Naruse H, Mori Y, Ishikawa T, Ando T, Kurokawa H, Kondo T, Nagamura Y, Ezaki K, Hishida H. Risk stratification using a combination of cardiac troponin T and brain natriuretic peptide in patients hospitalized for worsening chronic heart failure. Am J Cardiol 89(6):691-5, 2002.
40. Thygesen K, Alpert JS, White HD et al, Joint ESC/ACCF/AHA/WHF Task Force for the Redefinition of Myocardial Infarction, Universal definition of myocardial infarction. Circulation 116(22):2634-53, 2007.
 
 
 
 
 
 
 
 
 
 
 
 
Está expresamente prohibida la redistribución y la redifusión de todo o parte de los contenidos de la Sociedad Iberoamericana de Información Científica (SIIC) S.A. sin previo y expreso consentimiento de SIIC.
ua31618
Inicio/Home

Copyright siicsalud © 1997-2024 ISSN siicsalud: 1667-9008