Usefulness of Cardiac Troponin T and Echocardiography in the Diagnosis of Hypoxic Myocardial Injury of Full-Term Neonates

Abstract

Background: Perinatal asphyxia constitutes a significant problem influencing neonatal mortality and morbidity. Objectives: The aim of the present work was to provide evidence of the usefulness of cardiac troponin T (cTnT) and echocardiographic investigations in the diagnosis of heart damage in full-term infants after intrauterine hypoxia. Material and Methods: The subjects were 39 asphyxiated and 44 term infants without fetal anoxia. Quantitative determinations of cTnT were performed between 12 and 24 h of life. Two-dimensional Doppler and color Doppler studies were performed at the bedside. We evaluated fractional shortening (FS), cardiac output (CO), cardiac index (CI), tricuspid (TI) and mitral (MI) insufficiency. Results: Asphyxiated infants presented increased cTnT (mean 0.141 ± 0.226 vs. 0.087 ± 0.111ng/ml; p < 0.01) and TI (38.5 vs. 11.4% of population; p < 0.05) compared to healthy infants. CO, CI and FS remained in the same range. Conclusions: We found cTnT to be the most useful among accessible diagnostic tools used in post-hypoxic heart damage in neonates. The data from our relatively small population study suggest a cTnT value of >0.1 ng/ml as a reliable marker of myocardial injury in neonates. Further study should be performed to generate a receiver-operator characteristic curve to discover what the cut-off level should be.

Interpretation of Cardiac Troponin Measurements in Neonates – The Devil Is in the Details

“…Neonates who suffer respiratory distress demonstrate elevation of cTnT. Recently, it has been shown that a cTnT value of 1 0.1 g/l (ng/ml) was a reliable marker of myocardial injury demonstrated by tricuspid insuffi ciency by two-dimensional Doppler and color Doppler imaging in asphyxiated neonates [16] .…”

Cardiac Troponin T: A Useful Early Marker for Cardiac and Respiratory Dysfunction in Neonates

“…Wide consensus has been established on the clinical utility of troponins in adults with acute coronary syndrome [1,3,10,15] . Although cardiovascular compromise is common in term and preterm sick infants [3,[16][17][18][19] , troponins have not been used routinely in neonates.…”

“…Although cardiovascular compromise is common in term and preterm sick infants [3,[16][17][18][19] , troponins have not been used routinely in neonates. Cardiac function has been demonstrated to be influenced by the severity of respiratory distress and its ventilatory management in this age group [1,20,21] .…”

Use of cardiac biomarkers in neonatology

“…The authors of that study found cTnT to be the most useful tool for assessing myocardial injury. In their study, echocardiography appeared to be of less value, apart from its help in the frequent diagnosis of tricuspid insufficiency, reported earlier as being more common in newborns who had experienced asphyxia (46). However, Costa et al did report such a relationship between higher cTnT levels and echocardiographic signs of myocardial compromise in infants who had experienced asphyxia.…”