190 - Creatine Kinase Predicts Low Cardiac Output in Neonatal Hypoxic-Ischemic Encephalopathy

Poster Number: 190
Publication Number: 190.219

Shiran Sara Moore, McGill University Faculty of Medicine and Health Sciences, Westmount, PQ, Canada; Anie Lapointe, CHU Ste-Justine, Montréal, PQ, Canada; Pia Wintermark, McGill University Faculty of Medicine and Health Sciences, Montreal, PQ, Canada; Emmanouil Rampakakis, McGill University Faculty of Medicine and Health Sciences, Montreal, PQ, Canada; Jessica simoneau, McGill University Faculty of Medicine and Health Sciences, Montreal, PQ, Canada; Alishia Poccia, McGill University Faculty of Medicine and Health Sciences, Montreal, PQ, Canada; Asim A. Balushi, National Heart Centre Oman, Muscat, Masqat, Oman; Gabriel Altit, McGill University Faculty of Medicine and Health Sciences, Montreal, PQ, Canada

Background: Neonates with hypoxic-ischemic encephalopathy (HIE) often present with cardiac dysfunction, considered to be associated with outcomes. No study has evaluated the relationship between serum cardiac biomarkers and detailed cardiac performance measures by echocardiography (ECHO).

Objective: To correlate cardiac biomarkers with serial ECHO parameters of ventricular performance in neonates with moderate to severe HIE.

Design/Methods: This was a single center prospective cohort study (2016-2021) of neonates undergoing therapeutic hypothermia (TH) for moderate to severe HIE in a tertiary neonatal intensive care unit. Infants with confirmed brain injury on day of life (DOL) 2 had repeated ECHO and cardiac biomarkers (creatine kinase [CK], troponin I and urotensin-2) measurements on DOL 2, 3, 4 and 10. Neonates without brain injury had measurements only on DOL 2. ECHO markers of cardiac performance were extracted offline. Extractors of the ECHO data were blinded to the biomarkers results. Generalized linear mixed effect models with random slopes/intercepts were used to account for repeated measurements. Receiver operating characteristic (ROC) curves were constructed to assess optimal thresholds for sensitivity/specificity of the biomarkers. Statistical significance was set at < 0.05.

Results: Fifty-six neonates had 128 same-day measurements of biomarkers and ECHO. For the cohort, gestational age at birth was 38.9±1.7 weeks, birth weight was 3.25±0.67 kg, and 37 (66%) were males. CK, troponin I and urotensin-2 significantly decreased over time (Table 1; p < 0.001, 0.004 and 0.02, respectively). Left and right ventricle outputs (LVO, RVO), Tricuspid Annular Plane Systolic Excursion and Tissue Doppler Velocities of the right ventricle significantly increased over time (Table 1; Figure 1), indicating improvement of systolic cardiac function by DOL 10. Of the three biomarkers, CK best correlated with ECHO measurements of cardiac function (Table 2; Figure 1). LVO significantly decreased by 35.4 mL/kg/min (p < 0.001) and RVO by 16.1 mL/kg/min (p=0.01) for each point increase in CK. A CK threshold of 1001 U/L was found to identify significant low cardiac output (i.e., LVO < 150 mL/kg/min) with 80% sensitivity and 50% specificity.Conclusion(s): Elevated CK correlated with decreased cardiac performance in neonates with moderate to severe HIE treated with TH. This biomarker could be used as a proxy for decreased ventricular output when echocardiography is not readily available.
CV Shiran Sara MooreCVShiranMooreDec2021.pdf
Table 1: Biomarkers and ECHO measurements over time