Abstract
Objective
Study the association between cardiac biomarkers and echocardiography parameters of ventricular performance in neonates with neonatal encephalopathy (NE).
Methods
Prospective observational study (2016–2021) of neonates undergoing therapeutic hypothermia (TH). Neonates with brain injury had repeated echocardiography and biomarkers measurements on day of life (DOL) 2, 3, 4, and 10. Pearson correlation and generalized linear mixed effect models were used to account for repeated measurements. Receiver operating characteristic curves were constructed to assess sensitivity/specificity.
Results
56 neonates had 128 measurements. Creatine Kinase (CK) and cardiac troponin-I (CTn-I) were associated with right ventricular (RV) function. A CK of 1961 U/L and a CTn-I of 91 ng/L identified low Tricuspid Annular Plane Systolic Excursion (<7 mm) with sensitivities of 93% and 79%, and specificities of 55% and 74%, respectively.
Conclusions
Elevated CK and CTn-I were associated with decreased RV performance. Trending these markers can be used to suspect altered RV function and may flag optimal timing for evaluation(s) by echocardiography during TH.
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Fig. 1: Mixed effects model for cardiac biomarkers and echocardiography measurements.
Fig. 2: Receiver operating characteristic (ROC) curves of CK, CTn-I and urotensin-II to predict low TAPSE < 7 mm and low RVO < 100 ml/kg/min.
Data availability
Derived data generated will be shared on reasonable request to the corresponding author.
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Acknowledgements
Results from this study were presented in abstract and poster formats at the Pediatric Academic Societies meeting (2022) and NeoHeart 2022 meeting.
Funding
Gabriel Altit is the principal investigator of the NeoCardioLab, which is supported by the Department of Pediatrics, “Just for Kids” Foundation, “Foundation of Stars” and Grand Défi Pierre Lavoie. Dr Altit holds a FRSQ Clinical Research Investigator award Junior. Pia Wintermark holds a William Dawson Scholar Award from the McGill Faculty of Medicine and Health Sciences and is supported by FRSQ Clinical Research Scholar Career Award Senior and a Canadian Institutes of Health Research (CIHR) Project Grant.
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Author notes
These authors contributed equally: Pia Wintermark, Gabriel Altit.
Authors and Affiliations
Montreal Children’s Hospital, McGill University Health Centre, Montreal, QC, Canada
Shiran Sara Moore, Emmanouil Rampakakis, Jessica Simoneau, Pierre Elias, Alishia Poccia, Asim Al Balushi, Adel Schwertani, Pia Wintermark & Gabriel Altit
Dana Dwek Children’s Hospital, Tel Aviv Souraski Medical Center, Tel Aviv University, Tel Aviv, Israel
Shiran Sara Moore
Department of Pediatrics, McGill University, Montreal, QC, Canada
Shiran Sara Moore, Emmanouil Rampakakis, Jessica Simoneau, Pierre Elias, Alishia Poccia, Asim Al Balushi, Adel Schwertani, Pia Wintermark & Gabriel Altit
Sainte Justine Children’s Hospital, University of Montreal, Montreal, QC, Canada
Anie Lapointe
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Shiran Sara Moore
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Contributions
Dr Moore contributed to conceptualizing and designing the study, realized cardiac ultrasounds, collected the data, analyzed the data, and drafted the initial and revised manuscript. Dr Lapointe contributed to conceptualizing and designing the study, realized cardiac ultrasounds, contributed to the interpretation of the findings and critically reviewed the manuscript. Dr Rampakakis contributed to the statistical analysis, analyzed some of the data and critically reviewed the manuscript. Mrs Simoneau realized cardiac ultrasounds, collected the data and critically reviewed the manuscript. Mr Elias collected the data and critically reviewed the manuscript. Dr Poccia collected the data and critically reviewed the manuscript. Dr Al Balushi contributed to conceptualizing and designing of the study, collected the data andcritically reviewed the manuscript. Dr Adel Schwertani contributed to the urotensin-II analysis, collected the data and critically reviewed the manuscript. Dr Wintermark conceptualized and designed the study, obtained funding, contributed to the interpretation of the findings, and critically reviewed the manuscript. Dr Altit conceptualized and designed the study, realized cardiac ultrasounds, supervised data analysis, contributed to the interpretation of the findings and critically reviewed the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
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Correspondence to Gabriel Altit.
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Moore, S.S., Lapointe, A., Rampakakis, E. et al. Cardiac biomarkers predict low right ventricle performance in neonatal encephalopathy. J Perinatol (2025). https://doi.org/10.1038/s41372-025-02262-9
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Received:29 September 2024
Revised:13 February 2025
Accepted:03 March 2025
Published:15 March 2025
DOI:https://doi.org/10.1038/s41372-025-02262-9
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