Diagnostic and prognostic role of troponin I in neonates with critical duct-dependent congenital heart diseases

Abstract

Background Cardiac troponins (cTn) are markers of myocardial injury with well established diagnostic value in adults. However, the benefits of using troponins in neonates with critical duct-dependent congenital cardiac diseases (cDD-CHDs) is questionable. Aim The study aimed to investigate the diagnostic role of cTnI in cDD-CHDs as a marker of myocardial injury and to explore its role in patient’s outcome. Methods A case-control study, conducted over 80 neonates; Group I: Forty neonates with cDD-CHDs and Group II: Forty healthy neonates. CBC, CRP, electrolytes, liver and kidney functions, cTnI and echocardiography were done for both groups in first week of life. Then serum level of cTnI were re-evaluated after 3 weeks from initial sampling. Results The mean value of serum cTnI was significantly higher among cases when compared to controls (0.91±1.88 ng/ml versus 0.003±0.006 ng/ml, P<0.001*). The diagnostic performance of cTn I for cardiac injury was at cut-off 0.03 ng/ml with sensitivity 65% and specificity 97.5%. However, the prognostic role of cTnI in predicting death was at serum level of 0.7 ng/ml with 61% sensitivity and 81% specificity. cTn I in cDD-CHD was positively correlated to the severity of heart failure (HF) based on Modified Ross Score. The mean value of survival of the cDD-CHDs neonates was 28.11 days when cTnI is >0.6 ng/ml. Conclusion Initial serum levels of cTnI of cDD-CHD neonates in first week of life might be a useful marker in predicting the 40-days-survival and outcome.