Cardiac troponin I levels and its relation to echocardiographic findings in infants of diabetic mothers

Abstract

BackgroundCardiomyopathy is noted in up to 40% of infants of diabetic mothers, and the exact mechanisms responsible for it are unknown. The aim of this study was to compare between infants of diabetic mothers (IDM) and infants of non- diabetic mothers (INDM) as regards cardiac troponin I (cTnI) levels (as a marker of cardiac dysfunction) and to examine the relationship between this marker and neonatal echocardiographic changes (cardiac structure and function).MethodsA prospective, comparative study included eighty full term neonates during the first three days of life, during the period from April 2008 to June 2011. They were divided into 2 groups, group I: included 40 infants of diabetic mothers (IDMs)and group II: included 40 infants of non diabetic healthy mothers as a control group.Results37.5% of the IDMs were large for gestational age and demonstrated a significantly lower blood glucose level than the control group (34.6 ± 11.3mg/dl Vs 77.2 ± 19.8 mg/dl respectively) , respiratory distress and cyanosis were the presenting signs in 67.5% of IDMs. Cardiac TnI on the second day of life increased significantly in infants of diabetic mothers in comparison to INDM (p < 0.006) . IDMs had a significant increase in left atrial thickness ( 11.5 ± 1.8mm in IDM Vs 10.5 ± 0.9mm in INDM P < 0.002*) and a significant increase in septal thickness (5.0 ± 1.2mm in IDM Vs 4.0 ± 0.5mm in INDM P < 0.001*). CTnI correlated positively with interventricular septum thickness (P-value = 0.002*). Cardiac TnI was significantly increased in IDMs with respiratory distress (P –value < 0.05).ConclusionsThis study demonstrated a highly significant positive correlation between cTnI level on the second day of life and the left ventricular end diastolic diameter (LVED) and interventricular septum diameter (IVSD). Cardiac troponin I (cTnI) is a useful biochemical marker for monitoring myocardial injury in infants of diabetic mothers. An elevated cTnI concentration in infants of diabetic mothers with respiratory distress was a good predictor for hypertrophic cardiomyopathy and/or left ventricular dysfunction.

Cardiac injury biomarkers in paediatric age: Are we there yet?

“…This finding could reflect myocardial compromise or an increase in the ventricular workload [50,68].…”

“…Troponin I has been used to detect myocardial compromise in newborns with hypoxia and asphyxia [47][48][49]. Troponin was also useful for monitoring myocardial injury in infants of diabetic mothers; an elevated troponin I in infants of diabetic mothers with respiratory distress was a good predictor for hypertrophic cardiomyopathy and/or left ventricular dysfunction [50] and life-threatening respiratory or hemodynamic distress [51]. Troponin I was significantly higher in the asphyxiated newborns who died compared to the group of asphyxiated newborns that survived; the cutoff value was 0.135 ng/mL with a sensibility of 0.85 and a specificity of 0.74 [52].…”

The maternal diabetes mellitus and consequences for newborn

“…Objawy kliniczne ze strony układu krą-żenia występują u 12,5% NMC. W badaniu echokardiograficznym oceniającym funkcję mięśnia sercowego częstość tego powikłania wzrasta do 40%, co wskazuje na możliwość bezobjawowego przebiegu kardiomiopatii [10].…”

Correlation of Cord blood Cardiac Troponin-T to Echocardiographic and Tissue Doppler Variables in Infants of Diabetics Mothers with and without Hypertrophic Cardiomyopathy

“…Functional subaortic obstruction may occur in severe cases (idiopathic hypertrophic subaortic stenosis) [4]. The exact mechanism of hypertrophic cardiomyopathy in infants of diabetic mothers is clear but it is suggested that fetal hyperinsulinism may trigger hyperplasia and hypertrophy of myocardial cells by increasing fat and protein synthesis [5]. Natural history of infant of diabetic mother related-hypertrophic cardiomyopathy appeared to be benign, with a resolution of symptoms within 2-4 weeks and a resolution of septal hypertrophy within 2-12 months [6].…”