Perugu S, Rehan V K, Chow S L, Baylen B
Harbor-UCLA Medical Center, Torrance, CA, USA.
Western University of Medicine at UCLA, Pomona, CA, USA.
J Neonatal Perinatal Med. 2014 Jan 1;7(3):213-22. doi: 10.3233/NPM-14814010.
Evaluate plasma markers of myocardial function and ischemia [B-type natriuretic peptide] (BNP) and cardiac troponin T (cTnT)] in relationship to echocardiographic indices of left ventricular (LV) function and severity of illness score (SNAPPE-II) in Very-Low-Birth-Weight-Infants (VLBWIs) prospectively.
Serial echocardiography studies, clinical data, BNP and cTnT were obtained in thirty VLBWIs on postnatal days 1, 2, 3 and 7.
BNP increased and cTnT decreased significantly day 1 through 3. BNP was significantly associated with patent ductus arteriosus (PDA), but did not correlate with LV function or cTnT and did not reflect use of inotropic medication. Cardiac troponin T increased with severity of illness, SNAPPE-II, score and was highest in babies receiving inotropic medication; Low cardiac output (CO) was common in the first seventy two hours and correlated negatively with cTnT (p < 0.01). A contractility index, the corrected LV mean velocity of circumferential fiber shortening, (mVcfc) was not related to cTnT. The LV mVcfc was inversely related to LV end systolic wall stress (p < 0.001) in all subgroups, and this index of contractility (mvcfc-ess) did not differ with large caliber PDA or use of inotropic medication.
Cardiac troponin T exclusively rather than a combined biomarker approach may be useful in assessing myocardial injury. Cardiac output was low in sick VLBWIs with myocardial ischemia. Left ventricular contractile state was apparently preserved in significantly ill babies with elevated cTnT. Further research is needed to define the complex relationship between biomarkers and echocardiographic indices.
前瞻性评估极低出生体重儿（VLBWIs）心肌功能和缺血的血浆标志物[B型利钠肽]（BNP）和心肌肌钙蛋白T（cTnT）与左心室（LV）功能的超声心动图指标及疾病严重程度评分（SNAPPE-II）之间的关系。
在30例VLBWIs出生后第1、2、3和7天进行系列超声心动图检查、收集临床数据、检测BNP和cTnT。
第1天至第3天，BNP显著升高，cTnT显著降低。BNP与动脉导管未闭（PDA）显著相关，但与LV功能或cTnT无关，也不反映正性肌力药物的使用情况。心肌肌钙蛋白T随疾病严重程度、SNAPPE-II评分升高而增加，在接受正性肌力药物治疗的婴儿中最高；低心输出量（CO）在最初72小时很常见，且与cTnT呈负相关（p<0.01）。收缩性指标，即校正后的左心室圆周纤维缩短平均速度（mVcfc）与cTnT无关。在所有亚组中，左心室mVcfc与左心室收缩末期壁应力呈负相关（p<0.001），且该收缩性指标（mvcfc-ess）在大口径PDA或使用正性肌力药物的情况下无差异。
单独使用心肌肌钙蛋白T而非联合生物标志物方法可能有助于评估心肌损伤。患有心肌缺血的患病VLBWIs心输出量较低。cTnT升高的重病婴儿左心室收缩状态明显保留。需要进一步研究来确定生物标志物与超声心动图指标之间的复杂关系。
