Does seizure activity lead to subtle left ventricular myocardial dysfunction as measured by cTnI and echocardiography in children with epilepsy?
Post-seizure serum cTnI elevation is associated with persistent subtle left ventricular myocardial dysfunction in children with epilepsy, suggesting a potential need for cardiac surveillance.
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 ( P = 0.035, 0.035, and 0.039 and r = −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.
Hafez et al. (Thu,) studied this question.