Detection of myocardial injury in perinatal asphyxia by echocardiography and cardiac biomarkers

Abstract

Perinatal hypoxia can induces cardiac (Cd) injury in the newborn and requires an early diagnosis. Cd troponin I (cTnI) is correlated to hypoxic myocardial lesion-may be a useful marker of it Objectives: to evaluate the utility of echocardiography(echo) and research of cTnI values for diagnosis of myocardial injury. Patients: 98 newborns (0–14 days), with perinatal hypoxia, without major Cd anomalies, to wich were performed: clinical exam, ECG, Rx.CT, echo, research of cTnT values. The patients had mainly signs of neurological post hypoxic suffering without signs of Cd distress. The Cd exam: tachycardia, systolic murmur (64 pts); RxCT: cardiomegaly (35); ECG: LV repolarization disturbances (37);. Echo at 2–7 days of life: the absence of severe Cd malformations; myocardial LV hypertrophy (42 pts); normal LV systolic function(all); LV diastolic dysfunction (45 pts).The importance of Cd involvement were correlated with signs of hypoxic ischemic encephalopathy. The pts received spironolactone 1 mg/kg/day for 1 month, then 1 mg/Kg at 2 days (the alternating pattern) for 2–3 months. Evolution: absence of new myocardial suffering signs, is maintains systolic murmur (2/3 pts); reevaluation of echo at 6 months: the reduction of the myocardial hypertrophy, normal LV diastolic function; elevated cTnT values (> 0.12 μg/l): 56% pts with perinatal hypoxic suffering. The perinatal hypoxia can induce the apparition of post hypoxic hypertrophic cardiomyopathy(HCMP)(69% pts), LV diastolic function disturbancies and normal systolic LV function, even if the signs of Cd suffering missing often; echo is the main method for diagnosis and follow up of perinatal hypoxic HCMP and is necessary from the first week of life; increased values of cTnT(> 0.12 μg/l) in perinatal asphyxia prove hypoxi c myocardial damage; traitement with spironolactone for 2–3 months induced improving of HCMP and normalising of LV diastolic disfunction and cTnI values.