Cardiac Troponin T and Cardiac Dysfunction in Extremely Low-Birth-Weight Infants

Cruz, M.A.; Bremmer, Y.A.; Porter, Brian; Gullquist, Scott D; Watterberg, Kristi L.; Rozycki, Henry J.

doi:10.1007/s00246-005-0942-3

Cited by 15 publications

(12 citation statements)

References 25 publications

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“…Moreover, cTnT was greatest in babies receiving dopamine with or without PDA. Similarly, Cruz et al also found highest levels of cTnT in babies requiring pressor support, and there was no relationship of cTnT with PDA, shortening fraction % or mVcfc in low birth weight babies (7). However, in our serial observations, multiple regression demonstrated CO inversely related to cTnT (Table2).…”

Section: Ctntsupporting

confidence: 71%

“…Despite prior studies [6,7], the information on sequential postnatal values of these markers in VLBWI and their hemodynamic implications is scant. In particular, no study has prospectively assessed the relationship of severity of illness [SNAPPE-II score [8][9][10][11][12], with sequential BNP, cTNT and related echocardiographic functional indices in VLBWIs during the first postnatal week.…”

Section: Introductionmentioning

confidence: 99%

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Plasma biomarkers and echocardiographic indices of left ventricular function in very low birth weight infants

Perugu

Rehan

Chow

et al. 2014

Journal of Neonatal-Perinatal Medicine

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OBJECTIVE: Evaluate plasma markers of myocardial function and ischemia [B-type natriuretic peptide] (BNP) and cardiac troponin T (cTnT)] in relationship to echocardiographic indices of left ventricular (LV) function and severity of illness score (SNAPPE-II) in Very-Low-Birth-Weight-Infants (VLBWIs) prospectively. STUDY DESIGN: Serial echocardiography studies, clinical data, BNP and cTnT were obtained in thirty VLBWIs on postnatal days 1, 2, 3 and 7. RESULTS: BNP increased and cTnT decreased significantly day 1 through 3. BNP was significantly associated with patent ductus arteriosus (PDA), but did not correlate with LV function or cTnT and did not reflect use of inotropic medication. Cardiac troponin T increased with severity of illness, SNAPPE-II, score and was highest in babies receiving inotropic medication; Low cardiac output (CO) was common in the first seventy two hours and correlated negatively with cTnT (p < 0.01). A contractility index, the corrected LV mean velocity of circumferential fiber shortening, (mVcfc) was not related to cTnT. The LV mVcfc was inversely related to LV end systolic wall stress (p < 0.001) in all subgroups, and this index of contractility (mvcfc-ess) did not differ with large caliber PDA or use of inotropic medication. CONCLUSION: Cardiac troponin T exclusively rather than a combined biomarker approach may be useful in assessing myocardial injury. Cardiac output was low in sick VLBWIs with myocardial ischemia. Left ventricular contractile state was apparently preserved in significantly ill babies with elevated cTnT. Further research is needed to define the complex relationship between biomarkers and echocardiographic indices.

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Section: Ctntsupporting

confidence: 71%

Section: Introductionmentioning

confidence: 99%

Plasma biomarkers and echocardiographic indices of left ventricular function in very low birth weight infants

Perugu

Rehan

Chow

et al. 2014

Journal of Neonatal-Perinatal Medicine

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“…Also, inotropic drugs were administered signifi cantly more frequently to asphyctic newborns (about two-fi fths of subjects) if compared to the control group (without such therapy). The main reason for administration of inotropes, as in other studies, was hypotension, which, if associated with hypovolemia and lactacidosis, increases oxygen consumption and further reduce cardiac contractility (7,9,23).…”

Section: Discussionmentioning

confidence: 92%

Can a single lactate value predict adverse outcome in critically ill newborn?

Simovic¹,

Stojkovic²,

Savic³

et al. 2015

BLL

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OBJECTIVES: The aim of this study was to investigate the role of the lactic acidosis, as an early predictor of signifi cant consequences and/or a fatal outcome in term neonates after a perinatal asphyxia. BACKGROUND: Severe perinatal asphyxia can generate multiple organ dysfunction and neonatal mortality. METHODS: In routine clinical practice, after an admission to the Intensive Care Unit, lactate concentration was determined in capillary blood samples during the fi rst one to six hours after birth in 55 term newborns with the post-asphyxial hypoxic-ischemic encephalopathy. The control group consisted of 36 healthy term neonates randomly selected in the maternity ward at the Gynecology and Obstetrics Clinic. RESULTS: Signifi cantly higher concentrations of lactate (p < 0.0005) were observed in term neonates with post asphyctic syndrome (8.63 ± 4.43 mmol/L) if compared to the control group subjects (1.04 ± 0.36 mmol/L). The increase in lactate level > 8.7mmol/L with 80 % sensitivity and 82 % specifi city indicated the development of the hypoxic-ischemic encephalopathy stage II/III, while the lactate level > 9.95 mmol/L was a predictor of death, with 75 % sensitivity and 74.4 % specifi city. CONCLUSION: Determination of lactate concentrations in serum of term newborns associated with risk factors for the perinatal asphyxia is a useful tool in diagnosing metabolic disorders and ischemic damage, particularly severe clinical forms (Tab. 2, Fig. 3, Ref. 34). Text in PDF www.elis.sk.

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“…This parameter is often depressed after birth asphyxia and is a useful marker of severity and a prognostic indicator in asphyxia (16). In addition, troponin T, a marker of cardiac injury, was measured (1,17). To assess activation or suppression of mitochondrial apoptotic and survival pathways in myocardial left ventricular tissue, the protein level of apoptosis executioner cysteinyl aspartate-specific protease-3 (caspase-3) was determined.…”

Section: Articles Seehase Et Almentioning

confidence: 99%

Propofol administration to the fetal–maternal unit reduces cardiac injury in late-preterm lambs subjected to severe prenatal asphyxia and cardiac arrest

et al. 2013

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Background: cardiac dysfunction is reported to occur after severe perinatal asphyxia. We hypothesized that anesthesia of the mother with propofol during emergency cesarean section (c-section) would result in less cardiac injury (troponin T) in preterm fetuses exposed to global severe asphyxia in utero than anesthesia with isoflurane. We tested whether propofol decreases the activity of proapoptotic caspase-3 by activating the antiapoptotic AKT kinase family and the signal transducer and activator of transcription-3 (sTAT-3). Methods: Pregnant ewes were randomized to receive either propofol or isoflurane anesthesia. A total of 44 late-preterm lambs were subjected to in utero umbilical cord occlusion (UcO), resulting in asphyxia and cardiac arrest, or sham treatment. After emergency c-section, each fetus was resuscitated, mechanically ventilated, and supported under anesthesia for 8 h using the same anesthetic as the one received by its mother. results: At 8 h after UcO, the fetuses whose mothers had received propofol anesthesia had lower plasma troponin T levels, and showed a trend toward a higher median left ventricular ejection fraction (LVeF) of 84% as compared with 74% for those whose mothers had received isoflurane. Postasphyxia activation of caspase-3 was lower in association with propofol anesthesia than with isoflurane. Postasphyxia levels of sTAT-3 and the AKT kinase family rose 655% and 500%, respectively with the use of propofol anesthesia for the mother. conclusion: The use of propofol for maternal anesthesia results in less cardiac injury in late-preterm lambs subjected to asphyxia than the use of isoflurane anesthesia. The underlying mechanism may be activation of the antiapoptotic sTAT-3 and AKT pathways. Multi-organ dysfunction is a common outcome of severe perinatal asphyxia (1,2). One of the organs significantly involved in the fate of the asphyctic newborn is the heart (3,4); it can compromise the oxygen supply of other organs, resulting in irreversible injury (5). It is therefore important to maintain adequate cardiac function in neonates who have undergone an asphyxic insult. Currently, the only available therapy for cardiac function in the neonatal setting after an ischemic insult consists in treatment with positive inotropic and/or vasoactive drugs. The impact of this measure is limited because it neither prevents nor attenuates the degree of the initial myocardial ischemic injury (6,7). Evidence has now accumulated that some anesthetics such as propofol are cardioprotective in adult patients exposed to myocardial ischemia (8)(9)(10), and that this propofol-related cardioprotection is mediated through the activation of signal transducer and activator of transcription (STAT)-3 and phosphoinositide-3-kinase/AKT (11). Isoflurane, a volatile anesthetic, also protects the adult heart from ischemia and reperfusion injury by intervening with the mitochondrial apoptosis pathway (12,13). Both anesthetics are rapid acting and reliable and are therefore used when prompt delivery of the fetus becomes e...

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Cardiac Troponin T and Cardiac Dysfunction in Extremely Low-Birth-Weight Infants

Cited by 15 publications

References 25 publications

Plasma biomarkers and echocardiographic indices of left ventricular function in very low birth weight infants

Plasma biomarkers and echocardiographic indices of left ventricular function in very low birth weight infants

Can a single lactate value predict adverse outcome in critically ill newborn?

Propofol administration to the fetal–maternal unit reduces cardiac injury in late-preterm lambs subjected to severe prenatal asphyxia and cardiac arrest

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