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An In vitro Model to Study Immune Responses of Human Peripheral Blood Mononuclear Cells to Human Respiratory Syncytial Virus Infection
Published on: December 10, 2013
Myocardial injury in children with respiratory syncytial virus infection
P A Checchia1, H J Appel, S Kahn
1Division of Pediatric Critical Care Medicine, Children's Memorial Hospital, Northwestern University, Chicago, IL, USA.
Insights
Respiratory syncytial virus (RSV) can cause myocardial damage in children, indicated by elevated cardiac troponin I (cTnI) levels. This cardiac injury is linked to cardiovascular events and the need for critical care interventions in pediatric patients.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Respiratory syncytial virus (RSV) is linked to extrapulmonary issues, including a sepsis-like syndrome.
- Myocardial dysfunction is a recognized complication of severe RSV infection in children.
Purpose of the Study:
- To investigate direct myocardial injury in children with RSV infection.
- To assess the utility of cardiac troponin I (cTnI) as a biomarker for RSV-associated myocardial damage.
Main Methods:
- Serial cTnI measurements were taken from pediatric intensive care unit (PICU) patients.
- Data from 22 RSV-infected patients and 11 controls were analyzed.
Main Results:
- Elevated cTnI levels were found in 54.5% of RSV patients.
- RSV patients had significantly higher average cTnI levels than controls.
- Positive troponin assays correlated with cardiovascular events, inotropic support, and mechanical ventilation.
Conclusions:
- A significant proportion of pediatric PICU patients with RSV exhibit myocardial damage detectable by troponin assays.
- This myocardial damage can be clinically significant, leading to cardiovascular instability and the need for inotropic support.
Objective:
Respiratory syncytial virus (RSV) infection is associated with a number of extrapulmonary manifestations, including a sepsis-like syndrome characterized by any combination of hypothermia, fever, apnea, hypovolemia, and myocardial dysfunction. We hypothesized that RSV can have a direct injurious effect on the myocardium of infants and children that can be detected by the presence of cardiac troponin I (cTnI), a highly sensitive and specific marker of myocardial injury, in the blood of patients infected with the virus.
Design:
Serial cTnI measurements were obtained from patients admitted with documented RSV infection to the pediatric intensive care unit (PICU).
Participants:
Data were collected and analyzed from 22 RSV infected patients and 11 control patients.
Results:
Elevated levels of cTnI were detected in 54.5% (12/22) of the study population during their PICU admission. The average cTnI level was significantly higher in the RSV infected group than in controls. There was a significant association between the presence of a positive troponin assay and the occurrence of a cardiovascular event, the need for inotropic support, and the requirement of mechanical ventilation. Patients who required inotropic support had a significantly higher cTnI level than the rest of the study population.
Conclusion:
A large percentage of children admitted to the PICU with RSV infection have myocardial damage as detected by the use of commercially available troponin assays. Additionally, in a portion of these patients, this damage is clinically significant, leading to cardiovascular instability and the need for inotropic support.
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