Zmiany poziomu troponiny I w surowicy krwi po napadach epilepsji: wskaźnik utrzymujących się subtelnych zaburzeń funkcji mięśnia lewej komory serca u dzieci z epilepsją
Changes in serum cardiac troponin I after seizures: A marker for persistent subtle left ventricular myocardial dysfunctions in children with epilepsy
W skrócie
Badanie pokazało, że u ponad jednej czwartej dzieci z epilepsją wzrasta poziom troponiny I (specjalnego białka ze serca) po napadach epilepsji, co wiąże się z subtelnym osłabieniem funkcji lewej komory serca widocznym w badaniu ultrasonograficznym. Chociaż po czterech tygodniach troponina wróciła do normy, zmiany w sercu utrzymywały się, co sugeruje ryzyko trwałego uszkodzenia mięśnia serca w przypadku powtarzających się napadów. Autorzy rekomendują dokładne monitorowanie funkcji serca u dzieci z epilepsją oraz lepszą kontrolę napadów w celu ochrony serca.
Oryginalny abstract (angielski)
BACKGROUND: Epilepsy is a common neurological disease in childhood. There is a widespread association of epilepsy with cardiovascular comorbidities. Therefore, the study aimed to assess left ventricular (LV) myocardial dysfunction in children with epilepsy using serum cardiac troponin I (cTnI) and various echocardiographic modalities. METHODS: The study was a prospective case-control study including 55 children diagnosed with epilepsy and 40 controls. Serum cTnI was measured in patients (12-24 h after seizure) and repeated after 4 weeks. Detailed conventional echocardiography with tissue Doppler imaging (TDI) and two-dimensional speckle tracking echocardiography (2D-STE) was performed in patients with elevated basal cTnI, and the echocardiographic parameters were re-evaluated after 4 weeks. RESULTS: Out of 55 children with epilepsy, cTnI was increased in 15 (27.5%). On postseizure echocardiography, LV diameters were significantly increased compared with controls; however, no other conventional parameters showed a significant difference. TDI-derived E/e' ratio, s' velocity, and myocardial performance index were significantly affected compared to healthy children. 2D-STE measured global longitudinal strain (GLS) and global circumferential strain (GCS) were significantly decreased in patients compared with controls. The s' velocity, GLS, and GCS were negatively correlated with cTnI level with ( = 0.035, 0.035, and 0.039 and = -0.53, -0.53, and -0.52), respectively. At 4-week follow-up, cTnI levels returned to normal; however, echocardiographic parameters remained unchanged. CONCLUSIONS: Postseizure serum cTnI is a valuable marker of persistent, subtle LV myocardial changes in epileptic children, especially TDI and 2D-STE-derived parameters. The normalization of cTnI is an indicator of the myocardial stunning process in children that would lead to persistent LV myocardial injury following recurrence of seizure, which warrants strict seizure control and cardiac surveillance.