Bakoš Matija, Braovac Duje, Potkonjak Ana-Meyra, Svaguša Tomo, Ćaleta Tomislav, Dilber Daniel, Bartoniček Dorotea, Filipović-Grčić Boris, Galić Slobodan, Vrančić Ana Lončar, Vogrinc Željka, Đurić Željko, Planinc Mislav, Novak Milivoj, Matić Toni
Department of Pediatrics, University Hospital Centre Zagreb, 10000 Zagreb, Croatia.
Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Centre, 10000 Zagreb, Croatia.
Rev Cardiovasc Med. 2023 May 18;24(5):147. doi: 10.31083/j.rcm2405147. eCollection 2023 May.
The use of high-sensitive cardiac troponin T (hsTnT) in urine as a marker of cardiac damage in children has not yet been reported. Elimination of cardiac troponins is dependent on renal function; persistently increased serum hsTnT concentrations were observed among individuals with impaired renal function. The aim of this study was to investigate serum and urine hsTnT levels and its correlation in infants and children younger than 24 months of age after cardiac surgery.
This study was conducted on 90 infants and children under 24 months of age who were divided into three groups. The experimental group consisted of patients with intracardiac surgery of ventricular septal defect (VSD), first control group consisted of infants with extracardiac formation of bidirectional cavopulmonary connection (BCPC), and the second control group consisted of healthy children. Troponin T values were determined in serum and urine at five time points: the first sample was taken on the day before cardiac surgery (measure 0) and the other four samples were taken after the surgery; immediately after (measure 1), on the first (measure 2), third (measure 3), and fifth postoperative day (measure 5). The first morning urine was sampled for determining the troponin T in the control group of healthy infants.
A positive correlation between troponin T values in serum and urine was found. Urine hsTnT measured preoperatively in children undergoing BCPC surgery was higher (median 7.3 [IQR 6.6-13.3] ng/L) compared to children undergoing VSD surgery (median 6.5 [IQR 4.4-8.9] ng/L) as well as to healthy population (median 5.5 [IQR 5.1-6.7] ng/L). After logarithmic transformation, there was no statistically significant difference in urine hsTnT concentration between the groups at any point of measurement preoperatively or postoperatively. Statistically significant negative correlation was found between serum and urine hsTnT concentrations and glomerular filtration rate estimated by creatinine clearance. Patients who underwent surgical repair of VSD had significantly higher concentrations of troponin T in serum on the first three postoperative measurements compared to those who had BCPC surgery.
According to the results of this study, renal function after cardiac surgery appears to have a major effect on the urinary hsTnT concentrations, and we cannot conclude that this is an appropriate marker for the assessment of postoperative myocardial damage in children. Nevertheless, more research is needed to reach a better understanding of the final elimination of cardiac troponins in children.
尿中高敏心肌肌钙蛋白T（hsTnT）作为儿童心脏损伤标志物的应用尚未见报道。心肌肌钙蛋白的清除依赖于肾功能；肾功能受损者血清hsTnT浓度持续升高。本研究旨在调查24个月以下婴幼儿心脏手术后血清和尿hsTnT水平及其相关性。
本研究对90例24个月以下的婴幼儿进行，分为三组。实验组为室间隔缺损（VSD）心脏内手术患者，第一对照组为双向腔肺连接（BCPC）心脏外手术婴幼儿，第二对照组为健康儿童。在五个时间点测定血清和尿中的肌钙蛋白T值：第一个样本在心脏手术前一天采集（测量0），其他四个样本在术后采集；术后立即（测量1）、第一天（测量2）、第三天（测量3）和第五天（测量5）。在健康婴幼儿对照组中采集晨尿样本以测定肌钙蛋白T。
血清和尿中肌钙蛋白T值呈正相关。与接受VSD手术的儿童（中位数6.5 [四分位间距4.4 - 8.9] ng/L）以及健康人群（中位数5.5 [四分位间距5.1 - 6.7] ng/L）相比，接受BCPC手术的儿童术前测定的尿hsTnT更高（中位数7.3 [四分位间距6.6 - 13.3] ng/L）。对数转换后，术前或术后任何测量点各组间尿hsTnT浓度无统计学显著差异。血清和尿hsTnT浓度与通过肌酐清除率估算的肾小球滤过率之间存在统计学显著负相关。与接受BCPC手术的患者相比，接受VSD手术修复的患者术后前三次测量时血清肌钙蛋白T浓度显著更高。
根据本研究结果，心脏手术后的肾功能似乎对尿hsTnT浓度有主要影响，我们不能得出这是评估儿童术后心肌损伤的合适标志物的结论。然而，需要更多研究以更好地了解儿童心肌肌钙蛋白的最终清除情况。
