Gaspard Nicolas
Epilepsy Curr. 2019 Jul-Aug;19(4):246-248. doi: 10.1177/1535759719856592. Epub 2019 Jun 30.
Blood Markers of Cardiac Stress After Generalized Convulsive Seizures. Nass RD, Motloch LJ, Paar V, Lichtenauer M, Baumann J, Zur B, Hoppe UC, Holdenrieder S, Elger CE, Surges R. . 2019;60(2):201-210. doi:10.1111/epi.14637. Epub 2019 Jan 15. PMID: 30645779 Objective: Generalized convulsive seizures (GCS) are associated with high demands on the cardiovascular system, thereby facilitating cardiac complications. To investigate occurrence, influencing factors, and extent of cardiac stress or injury, the alterations and time course of the latest generation of cardiac blood markers were investigated after documented GCS.
Adult patients with refractory epilepsy who underwent video-electroencephalography monitoring along with simultaneous one-lead electrocardiography recordings were included. Cardiac biomarkers (cardiac troponin I [cTNI]; high-sensitivity troponin T [hsTNT]; N-terminal prohormone of brain natriuretic peptide; copeptin; suppression of tumorigenicity-2 [SST-2]; growth differentiation factor 15, [GDF-15]; soluble urokinase plasminogen activator receptor [suPAR]; and heart-type fatty acid binding protein [HFABP]) and catecholamines were measured at inclusion and at different time points after GCS. Peri-ictal cardiac properties were assessed by analyzing heart rate (HR), HR variability (HRV), and corrected QT intervals (QTc).
Thirty-six GCS (6 generalized-onset tonic-clonic seizures and 30 focal to bilateral tonic-clonic seizures) were recorded in 30 patients without a history of cardiac or renal disease. Postictal catecholamine levels were elevated more than 2-fold. A concomitant increase in HR and QTc, as well as a decrease in HRV, was observed. Elevations of cTNI and hsTNT were found in 3 (10%) of 30 patients and 6 (26%) of 23 patients, respectively, which were associated with higher dopamine levels. Copeptin was increased considerably after most GCS, whereas SST-2, HFABP, and GDF-15 displayed only subtle variations, and suPAR was unaltered in the postictal period. Cardiac symptoms did not occur in any patient.
The use of more sensitive biomarkers such as hsTNT suggests that signs of cardiac stress occur in about 25% of the patients with GCS without apparent clinical symptoms. Soluble urokinase plasminogen activator receptor may indicate clinically relevant troponin elevations. Copeptin could help to diagnose GCS but specificity needs to be tested.
全身性惊厥发作后心脏应激的血液标志物。纳斯·R·D、莫特洛赫·L·J、帕尔·V、利希特瑙尔·M、鲍曼·J、祖尔·B、霍佩·U·C、霍尔登里德·S、埃尔格·C·E、苏尔热斯·R。《癫痫》2019年；60(2):201 - 210。doi:10.1111/epi.14637。2019年1月15日在线发表。PMID: 30645779 目的：全身性惊厥发作（GCS）与心血管系统的高负荷相关，从而易引发心脏并发症。为研究心脏应激或损伤的发生情况、影响因素及程度，在记录的GCS发作后，对新一代心脏血液标志物的变化及时间进程进行了研究。
纳入成年难治性癫痫患者，这些患者接受视频脑电图监测并同时进行单导联心电图记录。在纳入时以及GCS发作后的不同时间点测量心脏生物标志物（心肌肌钙蛋白I [cTNI]；高敏肌钙蛋白T [hsTNT]；脑钠肽N末端前体激素； copeptin；抑瘤素M [SST - 2]；生长分化因子15 [GDF - 15]；可溶性尿激酶型纤溶酶原激活剂受体[suPAR]；以及心脏型脂肪酸结合蛋白[HFABP]）和儿茶酚胺。通过分析心率（HR）、心率变异性（HRV）和校正QT间期（QTc）评估发作期心脏特性。
在30例无心脏或肾脏疾病史的患者中记录到36次GCS发作（6次全面性强直阵挛发作和30次局灶性继发全面性强直阵挛发作）。发作后儿茶酚胺水平升高超过2倍。观察到HR和QTc同时升高以及HRV降低。分别在30例患者中的3例（10%）和23例患者中的6例（26%）发现cTNI和hsTNT升高，这与较高的多巴胺水平相关。大多数GCS发作后copeptin显著升高，而SST - 2、HFABP和GDF - 15仅表现出细微变化，发作后期suPAR未改变。所有患者均未出现心脏症状。
使用更敏感的生物标志物如hsTNT表明，约25%的GCS患者会出现心脏应激迹象，但无明显临床症状。可溶性尿激酶型纤溶酶原激活剂受体可能提示临床上相关的肌钙蛋白升高。copeptin有助于诊断GCS，但特异性有待检验。
