Myocardial injury and its association with venom-induced coagulopathy following Bothrops atrox snakebite envenomation

Abstract

Backgound

In Brazil, the highest incidences of snakebite envenomation (SBE) occur in the Amazon region, caused mostly by Bothrops atrox. Among the effects of envenomation, cardiac alterations are not a frequent outcome but are highly linked to severe cases.

Objective

The present study investigated the serum profile of cardiac injury markers (fatty acid binding protein 3 - H-FABP3, N-terminal type B natriuretic peptide - NTproBNP, creatine kinase-MB - CPK-MB, and troponin I) following Bothrops SBEs and their association with venom-induced coagulopathy.

Methods

Plasma markers were evaluated from blood collected at admission (before antivenom - T0) and 48h after antivenom (T48) from 80 B. atrox SBE patients treated at a tertiary hospital in Manaus, Brazilian Amazon, and 20 healthy donors.

Results

Markers were found increased, above reference range or compared to sex- and age-matched healthy controls, including FABP3 in at least 98.7% of patients, Troponin I 12.5%, and CK-MB in 8.8%. Regarding correlations to coagulation markers, alpha 2-antiplasmin concentrations were negatively correlated with FABP3 levels (T0), whereas FDP, tissue factor, and plasma factor VII levels were positively correlated with troponin I concentrations. Moreover, the group of patients with increased troponin I levels presented significantly higher FDP concentrations, factor VII levels, and risk for systemic bleeding at T0, whereas higher D-dimer concentrations at T48.

Conclusions

Our findings show that Bothrops SBE is responsible for myocardial injury, although not associated with severe outcomes, and its directly associated to venom-induced coagulopathy, indicating troponin-I and FABP3 as possible markers to screen patients for more detailed cardiac alterations.