Matter Mohamed, Abdel-Hady Hesham, Attia Gehan, Hafez Mona, Seliem Wael, Al-Arman Mohamed
Pediatric Cardiology Unit, Mansoura University Children's Hospital, Mansoura, Egypt.
Pediatr Cardiol. 2010 Jul;31(5):634-42. doi: 10.1007/s00246-010-9661-5. Epub 2010 Feb 9.
The aim of this study was to assess myocardial performance of full-term infants with perinatal asphyxia using Doppler tissue imaging (DTI) and to correlate it with serum cardiac troponin T (cTnT) concentrations. Twenty-five asphyxiated and 20 nonasphyxiated term infants were investigated. Serum cTnT concentrations were measured between 12 and 24 h of life. Conventional two-dimensional Doppler echocardiography and DTI were done during the first 72 h of life. Right ventricular (RV) and left ventricular (LV) Tei indexes were significantly higher in asphyxiated neonates (mean +/- SD: 0.45 +/- 0.05 vs. 0.28 +/- 0.05, P < 0.001 and 0.51 +/- 0.04 vs. 0.38 +/- 0.04, P < 0.001, respectively). Mitral and tricuspid systolic (Sm) velocities were significantly lower in asphyxiated neonates (mean +/- SD: 5.06 +/- 0.89 vs. 6.89 +/- 0.94 cm/s, P < 0.001 and 5.78 +/- 0.58 vs. 6.69 +/- 0.87 cm/s, P < 0.001, respectively). cTnT concentrations were significantly higher in asphyxiated neonates [median (range): 0.17 (0.05-0.23) vs. 0.03 (0-0.07) microg/l, P < 0.001)], and they correlated positively with the LV Tei index (r = 0.67, P < 0.001) and the RV Tei index (r = 0.68, P < 0.001) and negatively with the mitral systolic (Sm) velocity (r = -0.68, P < 0.001) and tricuspid systolic (Sm) velocity (r = -0.41, P = 0.01). A higher cTnT was a significant predictor of mortality, whereas fractional shortening (FS) and DTI measurements did not show any significant predictive value. The DTI technique appears to be more sensitive than conventional echocardiography in the early detection of myocardial dysfunction induced by perinatal asphyxia in full-term infants.
本研究旨在使用多普勒组织成像（DTI）评估足月围产期窒息婴儿的心肌功能，并将其与血清心肌肌钙蛋白T（cTnT）浓度相关联。对25例窒息足月婴儿和20例非窒息足月婴儿进行了研究。在出生后12至24小时测量血清cTnT浓度。在出生后的头72小时内进行传统二维多普勒超声心动图和DTI检查。窒息新生儿的右心室（RV）和左心室（LV）Tei指数显著更高（平均值±标准差：0.45±0.05对0.28±0.05，P<0.001；0.51±0.04对0.38±0.04，P<0.001）。窒息新生儿的二尖瓣和三尖瓣收缩期（Sm）速度显著更低（平均值±标准差：5.06±0.89对6.89±0.94cm/s，P<0.001；5.78±0.58对6.69±0.87cm/s，P<0.001）。窒息新生儿的cTnT浓度显著更高[中位数（范围）：0.17（0.05 - 0.23）对0.03（0 - 0.07）μg/l，P<0.001]，并且它们与LV Tei指数呈正相关（r = 0.67，P<0.001）和RV Tei指数呈正相关（r = 0.68，P<0.001），与二尖瓣收缩期（Sm）速度呈负相关（r = -0.68，P<0.001）和三尖瓣收缩期（Sm）速度呈负相关（r = -0.41，P = 0.01）。较高的cTnT是死亡率的显著预测指标，而缩短分数（FS）和DTI测量未显示任何显著的预测价值。DTI技术在足月婴儿围产期窒息所致心肌功能障碍的早期检测中似乎比传统超声心动图更敏感。
