132 Predictive Value of Cardiac Troponin T (CTNT) in the Diagnosis of Cardiac Dysfunction in Asphyxiated Full-Term Infants

Abstract

In the last years several reports on exploiting cardiac troponin T in the retrospective diagnosis of perinatal asphyxia have been published. Application of these method in neonates still stays open. Aim of the study was to evaluate usefulness of cTnT determination in the diagnosis of hypoxic myocardial injury in full-term infants. Material and method: 105 neonates >37 weeks of gestation were enrolled into the study. We separated study group of 45 asphyxiated neonates (umbilical pH<7,10, BE<-12mmol/1), with mean gestational age 38,7±1,3 weeks and birth weight 3246,4±587,0 g and control group (60 non-asphyxiated infants) with mean gestational age 38,6±1,5 weeks and birth weight 3374,8±496,9g. Quantitative determinations of cTnT in blood serum were performed between 12th and 24th hour of life using Elecsys cTnT STAT Immunoassay, that contains specific monoclonal antibodies against human cTnT. Results: cTnT levels were higher in the asphyxiated infants comparing to controls (0,21+/-103ng/ml and 0,054+/-0,039ng/ml, respectively) (p<0,00001). ROC curve proved that cTnT had high value in the diagnosis of posthypoxic myocardial injury in newborn. Discriminate value of cTnT was 0,060ng/ml (sensitivity 71,1%, specificity 66,7%, positive predictive value 61,5%). cTnT levels correlated with pH and BE in umbilical blood (p<0,00001 and p<0,00001, respectively), Apgar score in the 1min and 5 min (p<0,0002 and p<0,0002, respectively), abnormal fetal heart pattern on cardiotocography (p<0,01). Conclusions: cTnT determination is useful method of myocardial injury diagnosis in full-term infants after perinatal asphyxia. Serum blood levels of cTnT indicate, that cardiac dysfunction in neonates who suffered intrauterine hypoxia is more frequent than would be diagnosed based solely on clinical symptoms.