Cardiac Troponin-T as a Marker of Myocardial Dysfunction in Term Neonates with Perinatal Asphyxia
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.
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.
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%.
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.
KeywordsPerinatal asphyxia Cardiac troponin–T (cTnT) Myocardial dysfunction Shock HIE (Hypoxic ischemic encephalopathy)
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.
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.
Compliance with Ethical Standards
Conflict of Interest
Source of Funding
State Board of Medical Research (SBMR), Govt. of Kerala.
- 1.Lawn JE, Cousins S, Zupan J; Lancet Neonatal Survival Steering Team. 4 million neonatal deaths: when? where? why? Lancet. 2005;365:891–900.Google Scholar
- 5.Güneś T, Oztürk MA, Köklü SM, Narin N, Köklü E. Troponin –T levels in perinatally asphyxiated neonates during the first 15 days of life. Acta Pediatr. 2005;94:1638–43.Google Scholar
- 11.Mandal Ravi RN, Gupta R, Kapoor AK. Evaluation of activity of creatine phosphokinase (CPK) and its isoenzyme CPK-MB in perinatal asphyxia and its implications for myocardial involvement. Bull NNF. 1999;13:2–7.Google Scholar
- 14.Goel M, Gohiya P, Yadav BS. Assessment of myocardial function in birth asphyxia. Int J Med Res Rev. 2013;1:228–32.Google Scholar
- 28.Adamcová M, Kokstein Z, Palicka V, Podholová M, Kostál M. Troponin T levels in the cord blood of healthy term neonates. Physiol Res. 1995;44:99–104.Google Scholar