Introduction
Anatomical anomalies of the heart are generally associated with abnormal hemodynamic load and neurohumoral activation. Brain natriuretic peptide (BNP) and its N-terminal prohormone fragment (NT-proBNP) found in the circulation are mainly expressed by ventricular cardiac myocytes in response to ventricular volume and pressure overload. It is also hypothesized that significant hemodynamic overload due to a left-to-right shunt can induce myocardial injury. Sensitive cardiac troponin I (cTnI) and high sensitive cardiac troponin T (cTnT) are currently considered to be the most sensitive and specific biochemical marker of myocardial injury. However, few reports have described the use of cTnI, cTnT assays for evaluating abnormal volume and pressure load in children with congenital heart disease. For that reason we want to evaluate cTnI and cTnT levels in children with left-right shunt congenital heart disease and effect of pulmonary hypertension on serum levels of cTnI and cTnT.
Methods-Results
We prospectively enrolled 69 clinically stable subjects, consisting of 51 patients with left to right shunt and 18 healthy children. The first group was also been divided two; 20 patients with pulmonary hypertension, and 31 patients without pulmonary hypertension. The mean age was 12.1 months (4 months and 3 years). BNP and pro-BNP levels were also measured simultaneously with the serum cTnI and cTnT. Cardiac catheterization was performed in 25 children with ventricular septal defect prior to surgery and 4 children for percutanous closure of ductus arteriozus. Serum cTnI and cTnT levels were significantly higher in pulmonary hypertensive patients. In particular, cTnT levels were significantly elevated related to pulmonary hypertension compared with cTnI (p <0.001, p:0.025 respectively).
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