Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India.
Department of Cardiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India.
Indian Heart J. 2020 Sep-Oct;72(5):431-434. doi: 10.1016/j.ihj.2020.07.020. Epub 2020 Aug 2.
This study was done to evaluate myocardial function by 2D Echocardiography and Cardiac biomarkers (cTnI, CK-MB, BNP) changes in patients of scorpion envenomation of grade II-IV and correlate mortality of envenomed children with myocardial dysfunction.
A total of 40 patients admitted consecutively with grade II and more scorpion envenomation from October 2015 to July2018 were enrolled in the study. The data included demographics, the time of presentation, clinical features, echocardiographic findings, electrocardiographic findings, cardiac biomarker levels at admission and discharge, use of inotropic medication, oral prazosin, time of discharge, and their outcome.
The most common ECG abnormality was sinus tachycardia 28 (70%) followed by low voltage complex 13 (32.5%) which got normalized at the time of discharge in majority. Cardiac troponin I (cTnI) levels were more than 0.1 ng/mL, suggesting myocarditis was present in 25 (62.5%) and got normalized at discharge. CK-MB levels were increased in 26 (65%) patients suggesting myocardial involvement. BNP levels were also increased in 24 (60%) patients suggesting heart failure and its value got normalized at discharge. Abnormal 2D Echo findings as reduced left ventricular ejection fraction (LVEF) was present in 18 (45%) cases suggesting myocardial dysfunction and became normal at discharge. The sensitivity, specificity, positive predictive value and negative predictive value of Cardiac troponin I (cTnI) considering ECHO cardiograph as gold standard were 100, 68.1, 72 and 100% respectively. One patient had died whose Ejection fraction was less than 30%.
Echocardiography and cTnI can identify subgroup of patients, who require early aggressive therapy. Echocardiography, if not available, cardiac troponin I level can guide early therapy and indicates the prognosis.
本研究旨在通过二维超声心动图和心脏生物标志物（cTnI、CK-MB、BNP）变化评估二级和四级蝎蜇伤患者的心肌功能，并将中毒儿童的死亡率与心肌功能障碍相关联。
2015 年 10 月至 2018 年 7 月连续收治的二级及以上蝎蜇伤患者 40 例，纳入本研究。数据包括人口统计学、就诊时间、临床特征、超声心动图发现、心电图发现、入院和出院时的心脏生物标志物水平、使用正性肌力药物、口服普萘洛尔、出院时间及转归。
最常见的心电图异常是窦性心动过速 28 例（70%），其次是低电压复合波 13 例（32.5%），多数在出院时恢复正常。肌钙蛋白 I（cTnI）水平>0.1ng/mL，提示存在心肌炎 25 例（62.5%），出院时恢复正常。肌酸激酶同工酶（CK-MB）水平升高 26 例（65%），提示心肌受累。脑钠肽（BNP）水平升高 24 例（60%），提示心力衰竭，出院时恢复正常。左心室射血分数（LVEF）降低的二维超声心动图异常 18 例（45%），提示心肌功能障碍，出院时恢复正常。以心电图为金标准，肌钙蛋白 I（cTnI）的敏感性、特异性、阳性预测值和阴性预测值分别为 100%、68.1%、72%和 100%。1 例患者因射血分数<30%而死亡。
超声心动图和 cTnI 可识别需要早期积极治疗的亚组患者。如果超声心动图不可用，cTnI 水平可指导早期治疗并提示预后。
