Sensitive Cardiac Troponins: Could They Be New Biomarkers in Pediatric Pulmonary Hypertension Due to Congenital Heart Disease?

Abstract

To analyze the role of sensitive cardiac troponin I (scTnI) and high-sensitive troponin T (hscTnT) in the determination of myocardial injury caused by volume and pressure load due to pulmonary hypertension (PH) and to investigate if these markers may be useful in the management of PH in childhood. Twenty-eight patients with congenital heart disease (CHD) with left to right shunt and PH, 29 patients with CHD with left to right shunt but without PH, and 18 healthy children, in total 75 individuals, were included in the study. All cases were aged between 4 and 36 months. Echocardiographic evaluation was performed in all cases, and invasive hemodynamic investigation was performed in 33 cases. Blood samples were obtained from all cases, for the measurement of brain natriuretic peptide (BNP), pro-brain natriuretic peptide (pro-BNP), sensitive cardiac troponin I (scTnI), and high-sensitive troponin T (hscTnT) levels. The mean BNP, pro-BNP, scTnI, and hsTnT levels were statistically significantly higher in patients with PH than in the patients without PH (p < 0.001). A statistically significant positive correlation was determined between pulmonary artery systolic pressure and scTnI and hscTnT levels (r = 0.34 p = 0.01, r = 0.46 p < 0.001, respectively) levels. Pulmonary hypertension determined in congenital heart diseases triggers myocardial damage independently of increased volume or pressure load and resistance, occurring by disrupting the perfusion via increasing ventricular wall tension and the myocardial oxygen requirement. Serum scTnI and hscTnT levels may be helpful markers to determine the damage associated with PH in childhood.

Serum High Sensitive Cardiac Troponin-T (hs-cTnT) as a Biomarker in Pediatric Pulmonary Hypertension due to Congenital Left to Right Cardiac Shunt

“…In the present study, hs-cTnT levels were statistically significantly higher in the PH group compared with the healthy control cases and the non-PH group. This is in agreement with Kayali et al [13], who reported that both hs-cTnI and hs-cTnT levels were statistically significantly higher in the PH group compared with the healthy control cases and CHD cases with normal pulmonary artery pressure (the non-PH group).…”

“…The present study showed that at hs-cTnT cut off value of [>85.2 pg/ml]; the sensitivity of hs-cTnT was (70%), specificity was (95%), Positive Predictive Value (PPV) was (93.3%), Negative Predictive Value (NPV) was (76%), and accuracy was (88.4%). This in agreement with Kayali [13], who reported that the sensitivity and specificity of serum hs-cTnT levels in the prediction of pulmonary hypertension were determined as 78% and 80%, respectively. Besides; in patients with CHD having higher serum hs-cTnI and hs-cTnT levels, there was an increased probability of the presence of pulmonary hypertension.…”

Lipocalin 2: could it be a new biomarker in pediatric pulmonary hypertension associated with congenital heart disease?

“…Our results also showed significantly higher serum hsTnT levels in patients with PH compared to those without PH, as also noted by Kayali et al [23]. Ventricular hypertrophy in response to higher ventricular pressure limits myocardial perfusion and increases oxygen demand, leading to a higher risk of myocardial injury and increased troponins [24].…”

Clinical Importance of High-Sensitivity Troponin T in Patients without Coronary Artery Disease

“…In CHD patients, PAH triggers myocardial damage independently from increased volume or pressure load and resistance and disrupts perfusion due to increased ventricular wall strain and myocardial oxygen requirement. Serum hscTnT levels are useful determinants for identifying PAH-related damage [38].…”