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Ferraro S, Biganzoli E, Mannarino S, Lanzoni M, Zuccotti G, Plebani M, Kavsak P. High-Sensitivity Cardiac Troponin and the Management of Congenital Heart Disease in Newborns and Infants. Clin Chem 2024; 70:486-496. [PMID: 38180125 DOI: 10.1093/clinchem/hvad215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/05/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Early cardiac interventions in newborns and infants suspected for congenital heart disease (CHD) decrease morbidity and mortality. After updating current evidence on the use of cardiac troponins (cTn) in the context of CHD for risk stratification at early ages, we discuss relevant issues, starting from the evidence that only the measurement of the cTnT form is useful in this population. CONTENT In newborns/infants with CHD, the cTnT concentration increase is correlated with: (a) cardiac stress and hemodynamic parameters, but not with the type of CHD; (b) volume overload/right ventricular pressure overload; (c) postoperative hypoperfusion injury and mortality; and (d) effects of cardioprotective strategies. For infants with CHD, high-sensitivity cTnT (hs-cTnT) concentrations >25 ng/L are an independent predictor of poor outcomes. Transitioning from cTnT to hs-cTnT in newborns/infants improves the identification of: (a) physiopathological mechanisms and factors that increased hs-cTnT early after birth; (b) myocardial injury, even when subclinical; (c) identification of patients requiring immediate therapeutic interventions; and (d) 99th percentile upper reference limits (URLs). However, no reliable URLs are currently available to allow the detection of myocardial injury associated with CHD in newborns/infants. SUMMARY Additional data evaluating the clinical value of hs-cTnT in the risk stratification of newborns/infants with CHD who may suffer myocardial injury is needed. Validating the measurement, possibly in amniotic fluid samples, and improving the interpretation of hs-cTnT concentrations in the prenatal period, at birth and within 1 year of age are crucial to change CHD mortality/morbidity trends in the pediatric population.
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Affiliation(s)
- Simona Ferraro
- Department of Pediatrics, Center of Functional Genomics and Rare Diseases, Buzzi Children's Hospital, Milan, Italy
- Pediatric Department, Buzzi Children's Hospital, Milan, Italy
| | - Elia Biganzoli
- Unit of Medical Statistics, Bioinformatics and Epidemiology, University of Milan, Milan, Italy
- Data Science Research Center, University of Milan, Milan, Italy
| | - Savina Mannarino
- Pediatric Cardiology Unit, Buzzi Children's Hospital, Milan, Italy
| | - Monica Lanzoni
- Epidemiology Unit, Territorial Healthcare Agency Insubria Varese, Varese, Italy
| | - Gianvincenzo Zuccotti
- Pediatric Department, Buzzi Children's Hospital, Milan, Italy
- Clinical Science, University of Milan, Milan, Italy
| | - Mario Plebani
- Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Peter Kavsak
- Department of Pathology and Molecular Medicine, McMaster University, Hamiton, ON, Canada
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2
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Taha M, Awny N, Ismail S, Ashaat EA, Senousy MA. Screening and evaluation of TBX20 and CITED2 mutations in children with congenital cardiac septal defects: Correlation with cardiac troponin T and caspase-3. Gene 2023; 882:147660. [PMID: 37481008 DOI: 10.1016/j.gene.2023.147660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/07/2023] [Accepted: 07/19/2023] [Indexed: 07/24/2023]
Abstract
Congenital cardiac septal defect (CCSD) is the main type of congenital heart disease and owns a very high mortality rate among newborns. CCSD is controlled by specific transcription factors, including T-box transcription factor 20 (TBX20) and Cbp/P300 interacting transactivator with Glu/Asp rich carboxy-terminal domain 2 (CITED2) which are key molecular actors in heart development. Here, we screened for mutations in TBX20 and CITED2 genes in Egyptian children with CCSD and assessed their association with CCSD susceptibility and with cardiac troponin T (cTnT) and the apoptotic marker caspase-3 as biochemical markers for CCSD. Thirty unrelated newborns and children affected with CCSD and 30 matched healthy controls with no personal history of cardiac diseases were recruited. Selection criteria were children (<18 years) with any age diagnosed with CCSD using ECHO. Mutational analysis and genotyping were done using PCR-Sanger DNA sequencing technique. Serum cTnT and caspase-3 were analyzed using ELISA. Sequencing analysis identified 2 TBX20 variants (c.766T>C and c.39T>C) in the CCSD and control groups and 2 CITED2 variants (c.12T>C and c.9C>T) in one CCSD patient, while were absent in controls. In silico analysis identified TBX20 c.766T>C (rs3999941) as a missense (F256L) pathogenic variant and the other three variants as synonymous and benign. Compared with controls, TBX20 c.766T>C TC genotype and minor C allele were candidate high-risk factors for CCSD. Besides, serum cTnT and caspase-3 were dramatically elevated in CCSD children compared to controls. TBX20 c.766T>C TC genotype was associated with high cTnT in CCSD children. Conclusively, we advocate TBX20 c.766T>C variant as a potential genetic marker for CCSD which might associate with high cTnT levels. CITED2 genetic variants might have rare incidence among Egyptian CCSD children. Serum cTnT and caspase-3 are useful markers for ascertaining CCSD in children. These data could be exploited in prenatal genetic counseling, pre-implantation genotyping, and therapy of CCSD.
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Affiliation(s)
- Mohamed Taha
- Department of Biochemistry, Faculty of Pharmacy, Cairo University, Cairo 11562, Egypt.
| | - Nourhan Awny
- Medical Molecular Genetics Department, Human Genetics and Genome Research Institute, National Research Centre, Giza, Egypt
| | - Somaia Ismail
- Medical Molecular Genetics Department, Human Genetics and Genome Research Institute, National Research Centre, Giza, Egypt
| | - Engy A Ashaat
- Clinical Genetics Department, Human Genetics and Genome Research Institute, National Research Centre, Giza, Egypt
| | - Mahmoud A Senousy
- Department of Biochemistry, Faculty of Pharmacy, Cairo University, Cairo 11562, Egypt; Department of Biochemistry, Faculty of Pharmacy and Drug Technology, Egyptian Chinese University, Cairo 11786, Egypt
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3
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Soveral I, Guirado L, Escobar-Diaz MC, Alcaide MJ, Martínez JM, Rodríguez-Sureda V, Bijnens B, Antolin E, Llurba E, Bartha JL, Gómez O, Crispi F. Cord Blood Cardiovascular Biomarkers in Left-Sided Congenital Heart Disease. J Clin Med 2022; 11:jcm11237119. [PMID: 36498692 PMCID: PMC9737470 DOI: 10.3390/jcm11237119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/19/2022] [Accepted: 11/25/2022] [Indexed: 12/05/2022] Open
Abstract
Fetal echocardiography has limited prognostic ability in the evaluation of left-sided congenital heart defects (left heart defects). Cord blood cardiovascular biomarkers could improve the prognostic evaluation of left heart defects. A multicenter prospective cohort (2013−2019) including fetuses with left heart defects (aortic coarctation, aortic stenosis, hypoplastic left heart, and multilevel obstruction (complex left heart defects) subdivided according to their outcome (favorable vs. poor), and control fetuses were evaluated in the third trimester of pregnancy at three referral centers in Spain. Poor outcome was defined as univentricular palliation, heart transplant, or death. Cord blood concentrations of N-terminal precursor of B-type natriuretic peptide, Troponin I, transforming growth factor β, placental growth factor, and soluble fms-like tyrosine kinase-1 were determined. A total of 45 fetuses with left heart defects (29 favorable and 16 poor outcomes) and 35 normal fetuses were included, with a median follow-up of 3.1 years (interquartile range 1.4−3.9). Left heart defects with favorable outcome showed markedly increased cord blood transforming growth factor β (normal heart median 15.5 ng/mL (6.8−21.4) vs. favorable outcome 51.7 ng/mL (13.8−73.9) vs. poor outcome 25.1 ng/mL (6.9−39.0), p = 0.001) and decreased placental growth factor concentrations (normal heart 17.9 pg/mL (13.8−23.9) vs. favorable outcome 12.8 pg/mL (11.7−13.6) vs. poor outcome 11.0 pg/mL (8.8−15.4), p < 0.001). Poor outcome left heart defects had higher N-terminal precursor of B-type natriuretic peptide (normal heart 508.0 pg/mL (287.5−776.3) vs. favorable outcome 617.0 pg/mL (389.8−1087.8) vs. poor outcome 1450.0 pg/mL (919.0−1645.0), p = 0.001) and drastically reduced soluble fms-like tyrosine kinase-1 concentrations (normal heart 1929.7 pg/mL (1364.3−2715.8) vs. favorable outcome (1848.3 pg/mL (646.9−2313.6) vs. poor outcome 259.0 pg/mL (182.0−606.0), p < 0.001). Results showed that fetuses with left heart defects present a distinct cord blood biomarker profile according to their outcome.
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Affiliation(s)
- Iris Soveral
- BCNatal, Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), 08028 Barcelona, Spain
- Obstetrics Department, Hospital General de Hospitalet, 08906 Barcelona, Spain
| | - Laura Guirado
- BCNatal, Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), 08028 Barcelona, Spain
| | - Maria C. Escobar-Diaz
- Pediatric Cardiology Department, Sant Joan de Déu Hospital, Esplugues de Llobregat, 08950 Barcelona, Spain
- Cardiovascular Research Group, Sant Joan de Deu Research Institute, Esplugues de Llobregat, 08028 Barcelona, Spain
| | - María José Alcaide
- Laboratory Medicine Department, Hospital Universitario La Paz, 28046 Madrid, Spain
- Research Institute IdiPAZ, 28029 Madrid, Spain
| | - Josep Maria Martínez
- BCNatal, Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), 08028 Barcelona, Spain
- Facultat de Medicina i Ciencies de la Salut, Universitat de Barcelona, 08007 Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), 28029 Madrid, Spain
| | - Víctor Rodríguez-Sureda
- BCNatal, Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), 08028 Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), 28029 Madrid, Spain
| | - Bart Bijnens
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
- Catalan Institution for Research and Advanced Studies ICREA, 08010 Barcelona, Spain
| | - Eugenia Antolin
- Research Institute IdiPAZ, 28029 Madrid, Spain
- Obstetrics and Gynecology Department, Hospital Universitario La Paz, 28046 Madrid, Spain
| | - Elisa Llurba
- Obstetrics and Gynecology Department, Santa Creu i Sant Pau University Hospital, 08025 Barcelona, Spain
- Facultat de Medicina, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - Jose L. Bartha
- Research Institute IdiPAZ, 28029 Madrid, Spain
- Obstetrics and Gynecology Department, Hospital Universitario La Paz, 28046 Madrid, Spain
| | - Olga Gómez
- BCNatal, Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), 08028 Barcelona, Spain
- Facultat de Medicina i Ciencies de la Salut, Universitat de Barcelona, 08007 Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-932-27-9333
| | - Fàtima Crispi
- BCNatal, Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), 08028 Barcelona, Spain
- Facultat de Medicina i Ciencies de la Salut, Universitat de Barcelona, 08007 Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), 28029 Madrid, Spain
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4
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Rao PS. Biomarkers and pulmonary stenosis. Echocardiography 2021; 39:5-6. [PMID: 34913198 DOI: 10.1111/echo.15218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 09/13/2021] [Accepted: 09/27/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- P Syamasundar Rao
- Department of Pediatrics, Division of Pediatric Cardiology, The University of Texas-Houston McGovern Medical School/Children's Memorial Hermann Hospital, Houston, Texas, USA
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5
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Detection of Early Myocardial Injury in Children with Ventricular Septal Defect Using Cardiac Troponin I and Two-Dimensional Speckle Tracking Echocardiography. Pediatr Cardiol 2020; 41:1548-1558. [PMID: 32656627 DOI: 10.1007/s00246-020-02410-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 07/03/2020] [Indexed: 10/23/2022]
Abstract
Children with ventricular septal defects (VSDs) are subjected to hemodynamic overload which causes myocardial injury and subsequent heart failure. Early stages of myocardial damage cannot be detected by conventional echocardiography. Two-dimensional speckle tracking echocardiography (2D-STE) and cardiac troponin I (cTnI) have been recently introduced as more accurate tools for early assessment of cardiovascular diseases. The purpose of this study is to evaluate the role of cardiac troponin I (cTnI) and 2D-STE in the early detection of VSD-induced myocardial injury. Thirty children with VSD (symptomatic and asymptomatic) and 30 controls were assessed serologically by measuring serum cTnI and by conventional echocardiography. STE was performed to measure the averaged global peak longitudinal systolic stain [G peak SL(AVG)]. Serum cTnI levels were significantly higher in patients when compared to controls (P < 0.05) and in the symptomatic group when compared to the asymptomatic group (P < 0.05). Serum cTn I level correlated positively with the left atrial (r = 0.37, P = 0.045) and left ventricular dimensions (r = 0.46, P = 0.01) and negatively with the G peak SL(AVG) (r = -0.39, P = 0.03). There were no statistically significant differences between patients and controls or between symptomatic and asymptomatic groups with regard to the G peak SL(AVG). The peak longitudinal systolic strain (measured by 2D-STE) is not affected despite the elevation of serum cTnI. Serum cTnI is a sensitive marker for early detection of myocardial injury in VSD patients even before the development of ventricular dilatation or dysfunction.
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6
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Stoica SC, Dorobantu DM, Vardeu A, Biglino G, Ford KL, Bruno DV, Zakkar M, Mumford A, Angelini GD, Caputo M, Emanueli C. MicroRNAs as potential biomarkers in congenital heart surgery. J Thorac Cardiovasc Surg 2020; 159:1532-1540.e7. [PMID: 31043318 DOI: 10.1016/j.jtcvs.2019.03.062] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 03/10/2019] [Accepted: 03/26/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Pediatric congenital heart surgery (CHS) involves intracardiac, valvular, and vascular repairs. Accurate tools to aid short-term outcome prediction in pediatric CHS are lacking. Clinical scores, such as the vasoactive-inotrope score and ventilation index, are used to define outcome in clinical studies. MicroRNA-1-3p (miR-1) is expressed by both cardiomyocytes and vascular cells and is regulated by hypoxia. In adult patients, miR-1 increases in the circulation after open-heart cardiac surgery, suggesting its potential as a clinical biomarker. Thus, we investigated whether perioperative circulating miR-1 measurements can help predict post-CHS short-term outcomes in pediatric patients. METHODS Plasma miR-1 was retrospectively measured in a cohort of 199 consecutive pediatric CHS patients (median age 1.2 years). Samples were taken before surgery and at the end of the operation. Plasma miR-1 concentration was measured by reverse transcription-quantitative polymerase chain reaction and expressed as miR-1 copies/μL and as relative expression to spiked-in exogenous cel-miR-39. RESULTS Baseline plasma miR-1 did not vary across different diagnoses, increased during surgery (204-fold median relative increase, P < .001), and was associated with aortic crossclamp duration postoperatively (P < .001). Importantly, miR-1 levels at the end of the operation positively correlated with intensive care stay (P < .001), early severe cardiovascular events (P = .01), and with high vasoactive-inotrope score (P = .001) and ventilation index (P < .001), suggesting that miR-1 could accelerate the identification of patients with cardiopulmonary bypass-related ischemic complications, requiring more intensive support. CONCLUSIONS Our study suggests miR-1 as a novel potential circulating biomarker to predict early postoperative outcome and inform clinical management in pediatric heart surgery.
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Affiliation(s)
- Serban C Stoica
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom; Royal Hospital for Children, University Hospitals Bristol National Health System Trust, Department of Cardiac Surgery and Cardiology, Bristol, United Kingdom
| | - Dan M Dorobantu
- Royal Hospital for Children, University Hospitals Bristol National Health System Trust, Department of Cardiac Surgery and Cardiology, Bristol, United Kingdom; "Professor C.C. Iliescu" Emergency Institute for Cardiovascular Diseases, Cardiology Department, Bucharest, Romania
| | - Antonella Vardeu
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Giovanni Biglino
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Kerrie L Ford
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Domenico V Bruno
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom; Royal Hospital for Children, University Hospitals Bristol National Health System Trust, Department of Cardiac Surgery and Cardiology, Bristol, United Kingdom
| | - Mustafa Zakkar
- Royal Hospital for Children, University Hospitals Bristol National Health System Trust, Department of Cardiac Surgery and Cardiology, Bristol, United Kingdom
| | - Andrew Mumford
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Gianni D Angelini
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom; Royal Hospital for Children, University Hospitals Bristol National Health System Trust, Department of Cardiac Surgery and Cardiology, Bristol, United Kingdom
| | - Massimo Caputo
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom; Royal Hospital for Children, University Hospitals Bristol National Health System Trust, Department of Cardiac Surgery and Cardiology, Bristol, United Kingdom; Rush Medical Center, Chicago, Ill
| | - Costanza Emanueli
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom; National Heart and Lung Institute, Imperial College London, London, United Kingdom.
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7
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Christmann M, Wipf A, Dave H, Quandt D, Niesse O, Deisenberg M, Hersberger M, Kretschmar O, Knirsch W. Risk factor analysis for a complicated postoperative course after neonatal arterial switch operation: The role of troponin T. CONGENIT HEART DIS 2018; 13:594-601. [PMID: 30019379 DOI: 10.1111/chd.12615] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 03/18/2018] [Accepted: 04/19/2018] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To find risk factors for a complicated early postoperative course after arterial switch operation (ASO) in neonates with d-transposition of the great arteries (dTGA). In addition to anatomical and surgical parameters, the predictive value of early postoperative troponin T (TnT) values in correlation to the early postoperative course after ASO is analyzed. METHODS Seventy-nine neonates (57 (72%) male) with simple dTGA treated by ASO between 2009 and 2016 were included in the analysis. A complicated early postoperative course (30 days) was defined by one of the following criteria: (A) moderate to severe cardiac dysfunction without rhythm disturbances, (B) rhythm disturbances causing hemodynamic instability with the need for medical treatment, (C) signs for ischemia in ECG, (D) need for surgical or catheter interventional reinterventions other than diagnostic, or (E) other reasons. RESULTS Forty of 79 patients (51%) showed a complicated early postoperative course after ASO, with 2 patients dying after 13 and 16 days. Patients with a complicated early postoperative course had a longer PICU stay (P < .001), needed longer mechanical ventilator support (P = .001) and longer inotropic support (P = .03), and more reinterventions (surgical or catheter interventional) were necessary (P = .001). Only the presence of a VSD (P = .001) and longer surgery duration (P = .026) were associated to a complicated postoperative course. TnT values only showed a trend toward higher values in patients with a complicated postoperative course (P = .06). A secondary rise in TnT was seen in 10 patients, ranging from 11.6% to 410.2%, of whom 7 could be classified in the complicated postoperative group. CONCLUSIONS The postoperative course after ASO in dTGA neonates is influenced by other cardiac comorbidities like a VSD with the need for surgical treatment, influencing surgery duration. Postoperative higher TnT values reflect a longer and more vulnerable intraoperative course with limited predictive value on the early postoperative course.
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Affiliation(s)
- Martin Christmann
- Pediatric Cardiology, University Children's Hospital, Zurich, Switzerland.,Children's Research Center, University of Zurich, Zurich, Switzerland
| | - Alexandra Wipf
- Pediatric Cardiology, University Children's Hospital, Zurich, Switzerland.,Children's Research Center, University of Zurich, Zurich, Switzerland
| | - Hitendu Dave
- Children's Research Center, University of Zurich, Zurich, Switzerland.,Division of Congenital Cardiovascular Surgery, University Children's Hospital, Zurich, Switzerland
| | - Daniel Quandt
- Pediatric Cardiology, University Children's Hospital, Zurich, Switzerland.,Children's Research Center, University of Zurich, Zurich, Switzerland
| | - Oliver Niesse
- Pediatric Cardiology, University Children's Hospital, Zurich, Switzerland.,Children's Research Center, University of Zurich, Zurich, Switzerland
| | - Markus Deisenberg
- Children's Research Center, University of Zurich, Zurich, Switzerland.,Department of Intensive Care Medicine and Neonatology, University Children's Hospital, Zurich, Switzerland
| | - Martin Hersberger
- Children's Research Center, University of Zurich, Zurich, Switzerland.,Division of Clinical Chemistry and Biochemistry, University Children's Hospital, Zurich, Switzerland
| | - Oliver Kretschmar
- Pediatric Cardiology, University Children's Hospital, Zurich, Switzerland.,Children's Research Center, University of Zurich, Zurich, Switzerland
| | - Walter Knirsch
- Pediatric Cardiology, University Children's Hospital, Zurich, Switzerland.,Children's Research Center, University of Zurich, Zurich, Switzerland
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Sensitive Cardiac Troponins: Could They Be New Biomarkers in Pediatric Pulmonary Hypertension Due to Congenital Heart Disease? Pediatr Cardiol 2018; 39:718-725. [PMID: 29340731 DOI: 10.1007/s00246-018-1811-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 01/04/2018] [Indexed: 12/24/2022]
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.
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9
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Neves AL, Henriques-Coelho T, Leite-Moreira A, Areias JC. Cardiac injury biomarkers in paediatric age: Are we there yet? Heart Fail Rev 2018; 21:771-781. [PMID: 27255332 DOI: 10.1007/s10741-016-9567-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The aim of this article is to evaluate the clinical utility of cardiac injury biomarkers in paediatric age. In December 2015, a literature search was performed (PubMed access to MEDLINE citations; http://www.ncbi.nlm.nih.gov/PubMed/ ). The search strategy included the following medical subject headings and text terms for the key words: "cardiac injury biomarkers", "creatine kinase-MB", "myoglobin", "troponin", "children", "neonate/s", "newborn/s", "infant/s" and echocardiography. In the paediatric population, troponins show a good correlation with the extent of myocardial damage following cardiac surgery and cardiotoxic medication and can be used as predictors of subsequent cardiac recovery and mortality. Elevation of cardiac injury biomarkers may also have diagnostic value in cases when cardiac contusion or pericarditis is suspected. Cardiac injury biomarkers are very sensitive markers for the detection of myocardial injury and have been studied in healthy newborns, after tocolysis, intrauterine growth restriction, respiratory distress and asphyxia. The proportion of newborns with elevated troponin was higher than that in ill infants, children, and adolescents and in healthy adults, suggesting that myocardial injury, although clinically occult, is common in this young age group. Results suggest that significant elevation of cord troponin is an excellent early predictor of severity of hypoxic-ischaemic encephalopathy and mortality in term infants. Cardiac biomarkers may also benefit centres without on-site echocardiography with evidence showing good correlation with echo-derived markers of myocardial function. Further studies are needed to better clarify the role of cardiac biomarkers in paediatric age and their correlation with echocardiographic parameters.
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Affiliation(s)
- Ana L Neves
- Department of Paediatric Cardiology, São João Hospital, Porto, Portugal. .,Department of Physiology and Cardiothoracic Surgery, Cardiovascular Research Centre, Faculty of Medicine, University of Porto, Porto, Portugal. .,Department of Paediatrics, Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Tiago Henriques-Coelho
- Department of Paediatrics, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Paediatric Surgery, São João Hospital, Porto, Portugal
| | - Adelino Leite-Moreira
- Department of Physiology and Cardiothoracic Surgery, Cardiovascular Research Centre, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Cardiothoracic Surgery, São João Hospital, Porto, Portugal
| | - José C Areias
- Department of Paediatric Cardiology, São João Hospital, Porto, Portugal.,Department of Physiology and Cardiothoracic Surgery, Cardiovascular Research Centre, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Paediatrics, Faculty of Medicine, University of Porto, Porto, Portugal
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10
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Christmann M, Valsangiacomo Büchel ER, Dave H, Klauwer D, Cavigelli-Brunner A. Prognostic value of troponin in infants with hypoplastic left heart syndrome between Stage I and II of palliation. Ann Pediatr Cardiol 2018; 11:56-59. [PMID: 29440831 PMCID: PMC5803978 DOI: 10.4103/apc.apc_113_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background The period between stage I and II procedure for treatment of hypoplastic left heart syndrome (HLHS) bears high mortality and morbidity. Methods We sought to analyze the prognostic value of Troponin T/I (Trop), a well-recognized marker for myocardial damage and heart failure, for predicting outcome in a retrospective analysis of 70 infants with HLHS at our institution between March 2001 and October 2014. Results Stage I procedure consisted of Norwood I operation in 35 (50%) and Hybrid-approach in 22 (31%) patients. Palliative care was chosen for 13 (19%) patients. Trop values were collected from clinical charts and were analyzed in relation to the overall outcome. Trop was significantly higher after Norwood I operation in comparison to Hybrid-approach (median 7.1 μg/l (0.7-20.9), vs 1.2 μg/l (0.3-17.9), P < 0.001). Overall mortality of treated patients was 39% (22 patients). Survival was 54% (19 patients) after Norwood and 73% (16 patients) after Hybrid-approach. Independently from the procedure used, maximal Trop and initial lactate values were significantly higher in non-survivors than in survivors, with median Trop of 9 μg/l (0.6-18.8) vs. 3.4 μg/l (0.4-20.9), P 0.007, and median lactate of 3.7 mmol/L (1.6-25) vs. 2.9 mmol/L (0.3-14.6), p 0.03. Reinterventions were required in 17 (30%) patients, 4 (11%) after Norwood and 13 (59%) after Hybrid procedure. No correlation was found between the need for reintervention and Trop levels in the interstage period. Conclusions Patients with HLHS have significantly higher Trop levels after Norwood procedure than after Hybrid-approach. Maximal Trop values were related to mortality, but did not correlate with the need for reinterventions.
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Affiliation(s)
- Martin Christmann
- University Children's Hospital, Heart Center, Pediatric Cardiology and Cardiac Surgery, Zurich, Switzerland.,Children's Research Center, University of Zurich, Zurich, Switzerland
| | - Emanuela R Valsangiacomo Büchel
- University Children's Hospital, Heart Center, Pediatric Cardiology and Cardiac Surgery, Zurich, Switzerland.,Children's Research Center, University of Zurich, Zurich, Switzerland
| | - Hitendu Dave
- University Children's Hospital, Heart Center, Pediatric Cardiology and Cardiac Surgery, Zurich, Switzerland.,Children's Research Center, University of Zurich, Zurich, Switzerland
| | - Dietrich Klauwer
- Children's Research Center, University of Zurich, Zurich, Switzerland.,University Children's Hospital, Heart Center, Department of Intensive Care Medicine and Neonatology, Zurich, Switzerland
| | - Anna Cavigelli-Brunner
- University Children's Hospital, Heart Center, Pediatric Cardiology and Cardiac Surgery, Zurich, Switzerland.,Children's Research Center, University of Zurich, Zurich, Switzerland
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11
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Abstract
OBJECTIVES In this review, we discuss the physiology, pathophysiology, and clinical role of troponin, lactate, and B-type natriuretic peptide in the assessment and management of children with critical cardiac disease. DATA SOURCE MEDLINE, PubMed. CONCLUSION Lactate, troponin, and B-type natriuretic peptide continue to be valuable biomarkers in the assessment and management of critically ill children with cardiac disease. However, the use of these markers as a single measurement is handicapped by the wide variety of clinical scenarios in which they may be increased. The overall trend may be more useful than any single level with a persistent or rising value of more importance than an elevated initial value.
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12
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Sugimoto M, Kuwata S, Kurishima C, Kim JH, Iwamoto Y, Senzaki H. Cardiac biomarkers in children with congenital heart disease. World J Pediatr 2015; 11:309-15. [PMID: 26454435 DOI: 10.1007/s12519-015-0039-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 09/12/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Most congenital heart diseases (CHDs) have specific hemodynamics, including volume and pressure overload, as well as cyanosis and pulmonary hypertension, associated with anatomical abnormalities. Such hemodynamic abnormalities can cause activation of neurohormones, inflammatory cytokines, fibroblasts, and vascular endothelial cells, which in turn contribute to the development of pathologic conditions such as cardiac hypertrophy, fibrosis, and cardiac cell damages and death. Measuring biomarker levels facilitates the prediction of these pathological changes, and provides information about the stress placed on the myocardial cells, the severity of the damage, the responses of neurohumoral factors, and the remodeling of the ventricle. Compared to the ample information on cardiac biomarkers in adult heart diseases, data from children with CHD are still limited. DATA SOURCES We reviewed cardiac biomarkers-specifically focusing on troponin as a biomarker of myocardial damage, amino-terminal procollagen type III peptide (PIIIP) as a biomarker of myocardial fibrosis and stromal remodeling, and B-type natriuretic peptide (BNP)/N-terminal proBNP as biomarkers of cardiac load and heart failure, by introducing relevant publications, including our own, on pediatric CHD patients as well as adults. RESULTS Levels of highly sensitive troponin I are elevated in patients with atrial septal defects (ASDs) and ventricular septal defects (VSDs). PIIIP levels are also elevated in patients with ASD, VSD, pulmonary stenosis, and Tetralogy of Fallot. Measurement of BNP and N-terminal proBNP levels shows good correlation with heart failure score in children. CONCLUSIONS In the treatment of children with CHD requiring delicate care, it is vital to know the specific degree of myocardial damage and severity of heart failure. Cardiac biomarkers are useful tools for ascertaining the condition of CHDs with ease and are likely to be useful in determining the appropriate care of pediatric cardiology patients.
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Affiliation(s)
- Masaya Sugimoto
- , Asahikawa, Japan.,Department of Pediatrics, Asahikawa Medical University, Asahikawa, Japan
| | - Seiko Kuwata
- , Asahikawa, Japan.,Department of Pediatric Cardiology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Clara Kurishima
- , Asahikawa, Japan.,Department of Pediatric Cardiology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Jeong Hye Kim
- , Asahikawa, Japan.,Department of Pediatric Cardiology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Yoich Iwamoto
- , Asahikawa, Japan.,Department of Pediatric Cardiology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Hideaki Senzaki
- , Asahikawa, Japan. .,Department of Pediatric Cardiology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan.
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13
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Ylänen K, Poutanen T, Savukoski T, Eerola A, Vettenranta K. Cardiac biomarkers indicate a need for sensitive cardiac imaging among long-term childhood cancer survivors exposed to anthracyclines. Acta Paediatr 2015; 104:313-9. [PMID: 25393922 DOI: 10.1111/apa.12862] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 10/26/2014] [Accepted: 11/10/2014] [Indexed: 11/26/2022]
Abstract
AIM The role that plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) and cardiac troponins T (cTnT) and I (cTnI) play in supplementing imaging to screen for cardiac late effects remains controversial and the impact of high-sensitivity cTnT and troponin-specific autoantibodies (cTnAAbs) remains unexplored. We studied the role of cardiac biomarkers as indicators of the late effects of anthracyclines among childhood cancer survivors. METHODS We measured NT-proBNP, cTnT, high-sensitivity cTnT, cTnI and cTnAAbs in 76 childhood cancer survivors at a median of 9 years after primary diagnosis. The survivors underwent conventional and real-time three-dimensional echocardiography and 62 underwent cardiac magnetic resonance imaging (MRI). RESULTS Of the survivors, four (5.3%) without risk factors for cardiotoxicity were cTnAAb-positive with an impaired cardiac function in MRI. Another four (5.3%) had an abnormal NT-proBNP level associated with an abnormal cardiac function and risk factors for cardiotoxicity. None showed measurable cardiac troponins, determined by the three different methods, with even the high-sensitivity cTnT-levels remaining normal. CONCLUSION Elevated plasma NT-proBNP or cTnAAbs indicated that childhood cancer survivors benefitted from being evaluated with modern imaging, despite normal function in conventional echocardiography. However, troponins did not seem to provide additional information on the late cardiotoxicity of anthracyclines.
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Affiliation(s)
- Kaisa Ylänen
- Department of Paediatrics; Tampere University Hospital; Tampere Finland
- University of Tampere; Tampere Finland
| | - Tuija Poutanen
- Department of Paediatrics; Tampere University Hospital; Tampere Finland
- University of Tampere; Tampere Finland
| | - Tanja Savukoski
- Department of Biotechnology; University of Turku; Turku Finland
| | - Anneli Eerola
- Department of Paediatrics; Tampere University Hospital; Tampere Finland
| | - Kim Vettenranta
- Hospital for Children and Adolescents; Helsinki Finland
- University of Helsinki; Helsinki Finland
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14
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Singhal N, Saha A. Bedside biomarkers in pediatric cardio renal injuries in emergency. Int J Crit Illn Inj Sci 2014; 4:238-46. [PMID: 25337487 PMCID: PMC4200551 DOI: 10.4103/2229-5151.141457] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Point of care testing (POCT) using biomarkers in the emergency department reduces turnaround time for clinical decision making. An ideal biomarker should be accurate, reliable and easy to measure with a standard assay, non-invasive, sensitive and specific with defined cutoff values. Conventional biomarkers for renal injuries include rise in serum creatinine and fluid overload. Recently, neutrophil gelatinase associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), cystatin C, interleukin-18 (IL-18) and liver fatty acid binding protein (L-FABP) have been studied extensively for their role in acute kidney injury associated with various clinical entities. Biochemical markers of ischaemic cardiac damage commonly used are plasma creatine kinase and cardiac troponins (cTn). Clinically valuable cardiac markers for myocardial injury in research at present comprise BNP/NT-proBNP and to a lesser extent, CRP, which are independent predictors of adverse events including death and heart failure. Current status of point of care biomarkers for diagnosis and prognostication of renal and cardiac injuries in pediatric emergency care is appraised in this review.
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Affiliation(s)
- Noopur Singhal
- Department of Pediatrics, Division of Pediatric Nephrology, Postgraduate Institute of Medical Education and Research Associated Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Abhijeet Saha
- Department of Pediatrics, Division of Pediatric Nephrology, Postgraduate Institute of Medical Education and Research Associated Dr. Ram Manohar Lohia Hospital, New Delhi, India
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