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Cardiac Troponin-T as a Marker of Myocardial Dysfunction in Term Neonates with Perinatal Asphyxia

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Abstract

Objectives

To describe the diagnostic test properties of Cardiac Troponin-T (cTnT) in predicting myocardial dysfunction in asphyxiated term neonates by taking echocardiography as the gold standard and to establish the optimum cut-off values of cTnT for myocardial dysfunction, shock, severe hypoxic ischemic encephalopathy (HIE) and mortality by receiver operator characteristic (ROC) curve analysis.

Methods

This was a prospective study based on diagnostic test evaluation. The study included 120 term asphyxiated neonates in a tertiary care neonatal intensive care unit (NICU) in Southern India from June 2011 through June 2015. All the neonates were clinically evaluated. Venous blood was taken at 4 h of life for cTnT estimation. Echocardiography was done within 24 h of birth.

Results

The mean cTnT level of asphyxiated term neonates was 0.207±0.289 ng/ml (mean ± SD). Asphyxiated neonates with myocardial dysfunction had higher cTnT levels (0.277±0.231) as compared to those without myocardial dysfunction (0.061±0.036, p = 0.0001). Using ROC curve, the cut-off cTnT values for myocardial dysfunction was 0.1145 ng/ml with sensitivity 92.4% and specificity 94.1%. Cardiac Troponin-T levels were significantly higher among asphyxiated neonates with shock (0.378±0.348, p = 0.0001) and the levels also correlated positively with increasing grades of HIE. The cut-off cTnT value for mortality was 0.2505 ng/ml with sensitivity 83.9% and specificity 96.6%.

Conclusions

In asphyxiated term neonates, early cTnT elevation is a marker for predicting myocardial dysfunction and elevated cTnT levels had high sensitivity and specificity. There was significant relation with increasing cTnT values and increasing grades of HIE.

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Acknowledgements

Dr Saboora Beegum - Professor & HOD, Department of Biochemistry, Govt. Medical college, Thiruvananthapuram for her role in supervising the biochemical estimation of cTnT.Dr Muralidharan Nair – Asst. Prof. of Medical Statistics (Retd), CERTC, Govt. Medical College, Thiruvananthapuram for his help in the statistical analysis.

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Authors and Affiliations

  1. Department of Pediatrics, SATH, Govt. Medical College, Thiruvananthapuram, Kerala, 695011, India

    Susy Joseph & Sobha Kumar

  2. Department of Pediatric Cardiology, SATH, Govt. Medical College, Thiruvananthapuram, Kerala, India

    Zulfikar Ahamed M & S. Lakshmi

Authors
  1. Susy Joseph
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  2. Sobha Kumar
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  3. Zulfikar Ahamed M
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  4. S. Lakshmi
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Contributions

SJ: Designed the study, collected & analysed the data, did the literature work, wrote the paper; SL and ZAM: Conducted the echocardiographic analysis; SK: Permitted to do the study in NICU, critically reviewed the manuscript and approved the final version. SK will act as guarantor for this paper.

Corresponding author

Correspondence to Susy Joseph.

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Source of Funding

State Board of Medical Research (SBMR), Govt. of Kerala.

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Joseph, S., Kumar, S., Ahamed M, Z. et al. Cardiac Troponin-T as a Marker of Myocardial Dysfunction in Term Neonates with Perinatal Asphyxia. Indian J Pediatr 85, 877–884 (2018). https://doi.org/10.1007/s12098-018-2667-3

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  • DOI: https://doi.org/10.1007/s12098-018-2667-3

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