Cardiac troponin T in pregnant women having intravenous tocolytic therapy

Abstract

We studied drug-induced cardiotoxic effects in 22 pregnant women having tocolysis with intravenous fenoterol and verapamil. Because CK-MB is released from the uterus and placenta, we used the determination of cardiac troponin T (cTnT) as it is one of the most sensitive and specific indicators of myocardial necrosis. Cardiac troponin T levels were within physiological range (0.08 +/- 0.01 microgram/l) in all healthy pregnant women tested between 32 and 36 weeks of gestation (control group). In the pregnant women having tocolysis cTnT levels started to increase slightly during the first day of treatment (0.10 +/- 0.03 microgram/l) and were significantly higher (p < 0.05) during the third day (0.35 +/- 0.14 microgram/l) of tocolytic therapy. The cTnT levels in cord blood (0.13 +/- 0.03 microgram/l) did not correspond with maternal cTnT concentrations.

ACCF 2012 Expert Consensus Document on Practical Clinical Considerations in the Interpretation of Troponin Elevations

“…60, No. 23, 2012 Newby et al December 11, :2427 Interpretation of Troponin Elevations statistically higher, abnormal levels (0.35 ng/ml mean) by the third day of treatment (342); again, no additional cardiac evaluation was done in this study, but the young age (24.4 Ϯ 1.2 years) and absent history of cardiac/coronary equivalent disorders makes underlying primary heart disease unlikely in this study population. Complicated pregnancies may be more likely to demonstrate troponin elevations.…”

Serum Troponin in Neonatal Intensive Care

“…Neonatal troponin values are unlikely to be influenced by maternal levels as the molecules are too large to cross the placenta. Shelton et al [21] measured cTnT in 117 paired arterial and venous cord blood samples, and found no difference, making transplacental transfer extremely unlikely [22] . …”

Should We Consider Bilirubin When Dosing Troponin in Newborns? Case Report

“…Previously Adamcova, researching Troponin T values in 15 healthy term newborns, showed that incidental haemolysis of blood samples can mimic pathological elevation of troponin T by interfering with the assay [13]. Wenk noticed that when hemolysate was added to plasma, cardiac Troponin I was increased from reference values to high values in a dose-related way.…”

“…Adamcova et al observed that neonates with in utero exposure to acute or long-term tocolytic therapy by h-sympathicomimetics showed detectable values of cardiac troponins, indicating myocardial damage in these neonates, as well as newborns subjected in utero to magnesium sulphate [6] [7]: infants with severe IRDS have higher levels than infants with moderate IRDS and increased troponin-I serum levels in preterm infants with severe IRDS are explained by myocardial injury or dysfunction due to impaired arterial oxygenation or reduction in cardiac output during treatment with mechanical ventilation [7,8].…”