Abstract 16382: Pulmonary Hypertension-induced Myocardial Injury: Evaluation Using A Highly Sensitive Cardiac Troponin-I Assay In Children With Congenital Heart Disease
Background: Cardiac troponin I (cTnI) is currently considered as the most sensitive and specific biochemical marker of acute coronary syndrome and acute myocardial infarction. However, few reports have described the use of cTnI assays for evaluating abnormal hemodynamic load in children with congenital heart disease (CHD). We hypothesized that significant hemodynamic overload due to a left-to-right shunt can cause myocardial injury.
Methods: A highly sensitive cTnI assay was used to measure the serum cTnI levels in 29 children with atrial septal defect (ASD), 29 children with ventricular septal defect (VSD), and 350 healthy children (controls). None of the patients had a history of cardiac ischemia. Cardiac catheterization was performed in the children with ASD and VSD to determine the ratio of pulmonary to systemic blood flow (Qp/Qs), the ratio of pulmonary to systemic arterial pressure (Pp/Ps), pulmonary vascular resistance (RpI), right ventricular end-diastolic volume (RVEDV) (% of normal), and left-ventricular end diastolic volume (LVEDV) (% of normal).
Results: Serum cTnI levels in both ASD and VSD patients were significantly higher than those in healthy controls (p < 0.05 and p < 0.01, respectively) (Fig. 1). Furthermore, serum cTnI levels were significantly correlated with Pp/Ps (r = 0.867, p < 0.001) in VSD patients (Fig. 2), while these levels did not correlate with Qp/Qs, RpI, RVEDV, or LVEDV in both ASD and VSD patients.
Conclusion: In children with VSD, serum cTnI level is considered to be a useful biomarker to evaluate pulmonary hypertension. These results suggest that significant pressure overload due to a left-to-right shunt promotes myocardial injury and may eventually cause irreversible myocardial remodeling in children with CHD.
- © 2010 by American Heart Association, Inc.