Ventricular function and high-sensitivity cardiac troponin T in preterm infants with neonatal sepsis

  • Nusarintowati Ramadhina
  • Rubiana Sukardi
  • Najib Advani
  • Rinawati Rohsiswatmo
  • Sukman T. Putra
  • Mulyadi M. Djer
Keywords: preterm neonatal sepsis, myocardial performance index, hs-cTnT


Background Hemodynamic instability in sepsis, especially in the neonatal population, is one of the leading causes of death in hospitalized infants. The major contribution for heart dysfunction in neonatal sepsis is the myocardial dysfunction that leads to decreasing of ventricular function. The combination of echocardiography and laboratory findings help us to understand the ventricular condition in preterm infants with sepsis.
Objective To assess for a correlation between ventricular function and serum high-sensitivity cardiac troponin T (hs-cTnT) level in preterm infants with neonatal sepsis.
Methods We prospectively studied 30 preterm infants with neonatal sepsis who were admitted to the neonatal intensive care unit (NICU) of Cipto Mangunkusumo Hospital from June 1 – August 31, 2013. The ventricular functions were measured using 2-dimensional echocardiography. The parameters of right ventricular (RV) function assessment were tricuspid annular plane systolic excursion (TAPSE) and RV myocardial performance index (MPI). For left ventricular (LV) performance, we assessed ejection fraction (EF), fractional shortening (FS), and LV-MPI. Serum hs-cTnT was measured and considered to be a marker of myocardial injury.
Results Subjects had a mean gestational age of 31.5 (SD 2.18) weeks and mean birth weight of 1,525 (SD 437.5) g. The mean LV function measured by MPI was 0.281 (SD 0.075); mean EF was 72.5 (SD 5.09)%; and mean FS was 38.3 (SD 4.29)%. The RV function measured by TAPSE was mean 6.85 (SD 0.94) and that measured by MPI was median 0.255 (range 0.17-0.59). Serum hs-cTnT level was significantly higher in non-survivors than in survivors [282.08 (SD 77.81) pg/mL vs. 97.75 (24.2-142.2) pg/mL, respectively P =0.023]. There were moderate correlations between LV-MPI and hs-cTnT concentration (r=0.577; P=0.001), as well as between RV-MPI and hs-cTnT concentration (r=0.502; P=0.005). The positive correlation between LV and RV-MPI in neonatal sepsis was strong (r=0.77; P <0.001).Conclusion Left and right ventricular MPI show positive correlations with hs-cTnT levels. Serum hs-cTnT is significantly higher in non survivors. As such, this marker may have prognostic value for neonatal sepsis patients.


Tomerak RH, El-Badawy AA, Hussein G, Kamel NR, Razak AR. Echocardiogram done early in neonatal sepsis: what does it add? J Investig Med. 2012;60:680-4.

Rohsiswatmo R. Pencegahan dan pengendalian infeksi neonatal pada unit perinatal dengan pendekatan balanced scorecard. [disertasi]. [Jakarta]: Universitas Indonesia; 2011.

Abdel-Hady HE, Matter MK, El-Arman MM. Myocardial dysfunction in neonatal sepsis: a tissue Doppler imaging study. Pediatr Crit Care Med. 2012;13:318-23.

Lakoumentas JA, Panou FK, Kotseroglou VK, Aggeli KI, Harbis PK. The Tei index of myocardial performance: applications in cardiology. Hellenic J Cardiol. 2005;46:52-8.

Parker MM, Shelhamer JH, Bacharach SL, Green MV, Natanson C, Frederick TM, et al. Profound but reversible myocardial depression in patients with septic shock. Ann Intern Med. 1984;100:483-90.

Kadivar M, Kiani A, Kocharian A, Shabanian R, Nasehi L, Ghajarzadeh M. Echocardiography and management of sick neonates in the intensive care unit. Congenit Heart Dis. 2008;3:325-9.

Kluckow M, Seri I, Evans N. Echocardiography and the neonatologist. Pediatr Cardiol. 2008;29:1043-7.

Eto G, Ishil M, Tei C, Tsutsumi T, Akagi T, Kato H. Assessment of global left ventricular function in normal children and in children with dilated cardiomyopathy. J Am Soc Echocardiogr. 1999;12:1058-64.

Zanotti Cavazzoni SL, Gugliemi M, Parrillo JE, Walker JT, Dellinger RP, Hollenberg SM. Ventricular dilation is associated with improved cardiovascular performance and survival in sepsis. Chest. 2010;138:848-55.

Luce WA, Hoffman TM, Bauer JA. Bench-to-bedside review: developmental influences on the mechanisms, treatment and outcomes of cardiovascular dysfunction in neonatal versus adult sepsis. Crit Care. 2007;11:228-36.

Mupanemunda RH. Cardiovascular support of the sick neonate. Current Paediatrics. 2006;16:176-81.

Vieillard-Baron A, Prin S, Chergui K, Dubourg O, Jardin F. Hemodynamic instability in sepsis: bedside assessment by Doppler echocardiography. Am J Respir Crit Care Med. 2003;168:1270-6.

Talreja D, Nishimura R, Oh JK. Estimation of left ventricular filling pressure with exercise by Doppler echocardiography in patients with normal systolic function: a simultaneous echocardiographic-cardiac catheterization study. J Am Soc Echocardiogr. 2007;20:477-9.

Lodha R, Arun S, Vivekanandhan S, Kohli U, Kabra SK. Myocardial cell injury is common in children with septic shock. Acta Paediatr. 2009;98:478-81.

Alp H, Karaarslan S, Baysal T, Cimen D, Ors R, Oran B. Normal values of left and right ventricular function measured by M-mode, pulsed Doppler and Doppler tissue imaging in healthy term neonates during a 1-year period. Early Hum Dev. 2012;88:853-9.

Bouhemad B, Nicolas-Robin A, Arbelot C, Arthaud M, Feger D, Rouby JJ. Acute left ventricular dilatation and shock-induced myocardial dysfunction. Crit Care Med. 2009;37:441-7.

Griffin MP, Lake DE, O’Shea TM, Moorman JR. Heart rate characteristics and clinical signs in neonatal sepsis. Pediatr Res. 2007;61:222-7.

Griffin MP, Lake DE, Moorman JR. Heart rate characteristics and laboratory tests in neonatal sepsis. Pediatrics. 2005;115:937-41.

Cui W, Roberson DA. Left ventricular Tei index in children: comparison of tissue Doppler imaging, pulsed wave Doppler, and M-mode echocardiography normal values. J Am Soc Echocardiogr. 2006;19:1438-45.

Maeder M, Fehr T, Rickli H, Ammann P. Sepsis-associated myocardial dysfunction: diagnostic and prognostic impact of cardiac troponins and natriuretic peptides. Chest. 2006;129:1349-66.

Correale M, Nunno L, Ieva R, Rinaldi M, Maffei GF, Magaldi R, et al. Troponin in newborns and pediatric patients. Cardiovasc Hematol Agents Med Chem. 2009;7:270-8.

Fernandez CJ, Akamine N, Knobel E. Cardiac troponin: a new serum marker of myocardial injury in sepsis. Intensive Care Med. 1999;25:1165-8.

How to Cite
Ramadhina N, Sukardi R, Advani N, Rohsiswatmo R, Putra ST, Djer MM. Ventricular function and high-sensitivity cardiac troponin T in preterm infants with neonatal sepsis. PI [Internet]. 31Jul.2015 [cited 25Sep.2022];55(4):203-. Available from:
Received 2015-11-26
Accepted 2015-11-26
Published 2015-07-31