מתוך medicontext.co.il
DELHI (Reuters Health) – According to researchers from Turkey, serum cardiac troponin-I, a specific marker for myocardial injury, is not useful in assessing myocardial damage in children with active rheumatic carditis.
Though the exact reason is not known, the levels of other biochemical markers of cardiac damage, such as creatine kinase-MB (CK-MB), are not elevated in rheumatic carditis, Dr. B?lent Oran and colleagues from the Selחuk ?niversitesi in Konya, Turkey, write in the October issue of the Indian Journal of Pediatrics. The paucity of studies on the diagnostic utility of the enzyme markers in active rheumatic carditis prompted them to undertake this study, they add.
Dr. Oran's team evaluated serum cardiac troponin-I, CK-MB and myoglobin levels in 27 children with active rheumatic carditis and 23 controls. The levels were measured on the day of diagnosis and days 3, 7, 14, and 21 after.
The researchers noted that troponin-I, CK-MB and myoglobin levels were not elevated in the rheumatic fever group. The troponin-I levels were less than 0.15 ng/dL in both the study group and controls.
Even among the rheumatic fever group, the troponin-I levels were similar in children with or without features of cardiac failure or cardiomegaly. Neither did the levels differ between those treated with steroids and those who received acetyl salicylic acid.
While myocardial degeneration takes place in rheumatic carditis, myocyte necrosis takes place in other forms of myocardial damage, the researchers note. "Rheumatic myocarditis seems to be more myocyte sparing or less destructive on myocytes," they write.
This difference in the nature of injury could possibly be the reason for normal levels of troponin and other markers in rheumatic carditis, and elevated levels in other forms of myocardial injury such as myocarditis and myocardial infarction, they postulate.
While recommending further trials, the researchers conclude that serum cardiac troponin-I has no role in "indicating myocyte injury for the diagnosis or management of myocarditis in patients with active rheumatic carditis."
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