Previous studies have shown that individuals with myocardial infarction (MI) and a lower hemoglobin (a transport protein for oxygen) (Hb) level have a worse outcome than patients with a higher Hb level, although they have a similar infarct size. Hb level is positively correlated with body surface area (BSA), which in turn is positively correlated with heart mass. Researchers from the University Medical Center Maribor aimed to demonstrate that patients with lower Hb would have smaller BSA and heart mass, based on the theory that these patients would have more heart muscle injury relative to heart mass, explaining the poorer prognosis.
The research included 6055 MI patients who were divided into seven groups based on Hb levels. Researchers took into consideration troponin, a protein found in heart muscles, as well, and the relationships between Hb and troponin/BSA and between troponin/BSA and 30-day mortality were examined. It was discovered that patients with lower Hb had reduced BSA. Furthermore, those with decreased Hb levels had higher troponin/BSA values. Troponin/BSA level was linked to 30-day mortality.
The findings suggest that a similar peak troponin value in patients with lower Hb levels implies greater injury of the heart muscle relative to heart mass. It’s still unclear if this connection is causative. However, this hypothesis explains the poorer outcome in patients with lower Hb levels. Therefore, troponin should be indexed to BSA to provide comparable information on heart injury relative to heart mass.
Prejšnje študije so pokazale, da imajo posamezniki z miokardnim infarktom (MI) in nižjo ravnjo hemoglobina (transportne beljakovine za kisik) (Hb) slabši izid kot bolniki z višjo ravnjo Hb, čeprav imajo podobno velikost infarkta. Raven Hb je pozitivno povezana s telesno površino (BSA), ki pa je pozitivno povezana s srčno maso. Raziskovalci UKC Maribor so želeli dokazati, da bi imeli bolniki z nižjim Hb manjši BSA in srčno maso, na podlagi teorije, da bi imeli ti bolniki več poškodb srčne mišice v primerjavi s srčno maso, kar pojasnjuje slabšo prognozo.
V raziskavo je bilo vključenih 6055 bolnikov z MI, ki so bili glede na raven Hb razdeljeni v sedem skupin. Raziskovalci so upoštevali tudi troponin, beljakovino, ki jo najdemo v srčnih mišicah, in preučili so razmerja med Hb in troponinom/BSA ter med troponinom/BSA in 30-dnevno umrljivostjo. Ugotovljeno je bilo, da imajo bolniki z nižjim Hb zmanjšan BSA. Poleg tega so imeli tisti z znižano koncentracijo Hb višje vrednosti troponina/BSA. Raven troponina/BSA je bila povezana s 30-dnevno umrljivostjo.
Ugotovitve kažejo, da podobna najvišja vrednost troponina pri bolnikih z nižjimi ravnmi Hb pomeni večjo poškodbo srčne mišice glede na srčno maso. Še vedno ni jasno, ali je ta povezava vzročna. Vendar ta hipoteza pojasnjuje slabši izid pri bolnikih z nižjo ravnjo Hb. Zato je treba troponin indeksirati v BSA, da zagotovi primerljive informacije o srčni poškodbi glede na srčno maso.
Reference: Kanic V, Kompara G, Suran D, Glavnik Poznic N. Untangling the relationship between hemoglobin, peak troponin level, and mortality in patients with myocardial infarction. Bosn J of Basic Med Sci [Internet]. 2022Feb.18 [cited 2022May13];. Available from: https://www.bjbms.org/ojs/index.php/bjbms/article/view/6744
Editor: Merima Bukva, MPharm
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