Cardiac troponin T and N-terminal-pro-B type natriuretic peptide reflect myocardial function in preterm infants

Abstract

Background: Cardiovascular compromise is increasingly recognized in preterm infants. Currently, echocardiography is the best tool to assess myocardial contractility and guide management. Elevated levels of cardiac troponin T (cTnT) and N-terminal-pro-B type natriuretic peptide (NTpBNP) are associated with poor myocardial contractility and low cardiac output in adults.Objective: To examine the range of cTnT and NTpBNP in preterm infants, to correlate NTpBNP and cTnT with echocardiographic markers of cardiac function and to assess the influence of antenatal and postnatal factors on these biochemical markers.Study Design: Plasma concentrations of cTnT and NTpBNP were measured in infants <1500 g at 12 h of age. These were correlated with simultaneous echocardiographic measures of myocardial function and output. Antenatal data, infant demographics and postnatal characteristics were prospectively recorded.Result: A total of 80 infant had samples taken and echocardiography performed. Their median (interquartile range) cTnT and NTpBNP values were 0.20 mg l À1 (0.11 to 0.40) and 1273 pmol l À1 (664 to 2798), respectively. There was a significant inverse correlation between cTnT and echocardiographic markers of myocardial function and stroke volume. NTpBNP significantly correlated with left atrial to aortic root ratio (LA:Ao). There was a weaker but significant negative correlation between NTpBNP and left ventricular (LV) function. The assays were not influenced by gestation, birth weight, gender or mode of delivery.Conclusion: cTnT and NTpBNP are correlated with echocardiographic measures of cardiac performance in preterm infants. Measurement of levels in the first hours of life may provide useful information regarding myocardial function and volume loading.

Cardiac Biomarkers as Indicators of Hemodynamic Adaptation during Postasphyxial Hypothermia Treatment

“…BNP has therefore been established as an accurate indicator of cardiovascular disease in infants and children [17]. BNP levels are closely related to myocardial dysfunction as diagnosed by echocardiography [18,19]. We found BNP levels to correlate with echocardiographic parameters representing ventricular size and volume.…”

N-terminal probrain natriuretic peptide and patent ductus arteriosus in preterm infants

“…The previous study 35 has also shown that NT-proBNP on day 3 significantly correlated with LA/Ao ratio, PDA diameter and descending aorta end-diastolic velocity, whereas the other study 37 reported that NT-proBNP at 12 h of age significantly correlated with respiratory distress syndrome and LA:Ao ratio, but not with ductal diameter and a negative correlation was seen between NT-proBNP and left ventricular mean velocity of circumferencetial fiber shortening and shortening fraction. The conflicting results in the degree of correlation between plasma level and related variables may reflect the differences in the postnatal age at time of measurement.…”

Measurement of systemic oxygen delivery and inotropy in healthy term neonates with the Ultrasonic Cardiac Output Monitor (USCOM)

“…However, while the place of echocardiography in neonates is firmly established in the detection of left ventricular myocardial dysfunction [31,32], it demands a high degree of technical competence and skilled interpretation. El-Khuffash [33] has suggested that plasma cardiac troponin (cTnT) should be used as an indirect marker of myocardial contractility and degree of myocardial compromise in preterm infants when specialized echocardiography is not readily available. Subsequent confirmatory studies of the usefulness of this method are lacking however.…”