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Background <p>Infants of diabetic mothers (IDMs) are predisposed to transient hypertrophic cardiomyopathy and subclinical myocardial dysfunction. However, validated diagnostic cut-off values for cardiac biomarkers in this population are lacking, and the relationship between a panel of multiple biomarkers and advanced echocardiographic indices has not been systematically established. This study aimed to evaluate cardiac troponin-I (cTnI), B-type natriuretic peptide (BNP), and creatine kinase-MB (CK-MB) in IDMs, correlate them with conventional and advanced echocardiographic parameters, and derive ROC-based diagnostic cut-off values for detecting echocardiographically defined cardiac dysfunction.</p> Methods <p>In this prospective cross-sectional study, 100 term IDMs and 50 healthy controls were enrolled. Maternal glycemic control was assessed using HbA1c. Neonatal serum cTnI, BNP, and CK-MB were measured within 24–48&#xa0;h of birth. Comprehensive echocardiography included M-mode measurements, left ventricular mass (Devereux formula), fractional shortening, myocardial performance index (pulsed-wave tissue Doppler at the lateral mitral annulus), E/A ratio, and E/E′ ratio. ROC analysis determined optimal diagnostic cut-offs.</p> Results <p>IDMs had significantly higher cTnI (0.42 ± 0.18 vs. 0.09 ± 0.03 ng/mL), BNP (165 ± 60 vs. 60 ± 20 pg/mL), and CK-MB (85 ± 25 vs. 45 ± 18 U/L) compared to controls (all <i>p</i> &lt; 0.001). Echocardiography revealed increased interventricular septal thickness and left ventricular mass (<i>p</i> &lt; 0.001), preserved fractional shortening, but elevated MPI and E/E′ ratio indicating diastolic dysfunction (both <i>p</i> &lt; 0.001). IDMs also had higher rates of transient tachypnea (18% vs. 4%, <i>p</i> = 0.02), feeding difficulties (15% vs. 2%, <i>p</i> = 0.01), and longer hospital stay (5.2 ± 2.1 vs. 3.1 ± 1.0 days, <i>p</i> &lt; 0.001). Maternal HbA1c correlated strongly with cTnI (<i>r</i> = 0.62) and BNP (<i>r</i> = 0.54). ROC analysis identified cTnI as the most accurate biomarker (AUC = 0.89; cut-off &gt; 0.12 ng/mL; sensitivity 88%, specificity 84%).</p> Conclusions <p>Elevated cTnI, BNP, and CK-MB in IDMs reflect cardiac stress linked to maternal hyperglycemia. Population-specific biomarker cut-offs, particularly cTnI &gt; 0.12 ng/mL, may facilitate non-invasive screening for subclinical cardiac dysfunction, guiding selective echocardiography use. These thresholds require prospective multicenter validation.</p>

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Biomarkers of cardiac injury in infants of diabetic mothers and its relation to echocardiographic findings

  • 期刊论文

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  • 发表日期：

    2026年4月21日

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  • Shimaa Abd Elrheam Shaker,
  • Gehan Mohamed Kamal Eldin,
  • Hekma Saad Farghaly,
  • Zeinab Mahmoud Elkady,
  • Tahra Mohamed Kamel,
  • Ashraf Mohamed El-Saghier

摘要

Background

Infants of diabetic mothers (IDMs) are predisposed to transient hypertrophic cardiomyopathy and subclinical myocardial dysfunction. However, validated diagnostic cut-off values for cardiac biomarkers in this population are lacking, and the relationship between a panel of multiple biomarkers and advanced echocardiographic indices has not been systematically established. This study aimed to evaluate cardiac troponin-I (cTnI), B-type natriuretic peptide (BNP), and creatine kinase-MB (CK-MB) in IDMs, correlate them with conventional and advanced echocardiographic parameters, and derive ROC-based diagnostic cut-off values for detecting echocardiographically defined cardiac dysfunction.

Methods

In this prospective cross-sectional study, 100 term IDMs and 50 healthy controls were enrolled. Maternal glycemic control was assessed using HbA1c. Neonatal serum cTnI, BNP, and CK-MB were measured within 24–48 h of birth. Comprehensive echocardiography included M-mode measurements, left ventricular mass (Devereux formula), fractional shortening, myocardial performance index (pulsed-wave tissue Doppler at the lateral mitral annulus), E/A ratio, and E/E′ ratio. ROC analysis determined optimal diagnostic cut-offs.

Results

IDMs had significantly higher cTnI (0.42 ± 0.18 vs. 0.09 ± 0.03 ng/mL), BNP (165 ± 60 vs. 60 ± 20 pg/mL), and CK-MB (85 ± 25 vs. 45 ± 18 U/L) compared to controls (all p < 0.001). Echocardiography revealed increased interventricular septal thickness and left ventricular mass (p < 0.001), preserved fractional shortening, but elevated MPI and E/E′ ratio indicating diastolic dysfunction (both p < 0.001). IDMs also had higher rates of transient tachypnea (18% vs. 4%, p = 0.02), feeding difficulties (15% vs. 2%, p = 0.01), and longer hospital stay (5.2 ± 2.1 vs. 3.1 ± 1.0 days, p < 0.001). Maternal HbA1c correlated strongly with cTnI (r = 0.62) and BNP (r = 0.54). ROC analysis identified cTnI as the most accurate biomarker (AUC = 0.89; cut-off > 0.12 ng/mL; sensitivity 88%, specificity 84%).

Conclusions

Elevated cTnI, BNP, and CK-MB in IDMs reflect cardiac stress linked to maternal hyperglycemia. Population-specific biomarker cut-offs, particularly cTnI > 0.12 ng/mL, may facilitate non-invasive screening for subclinical cardiac dysfunction, guiding selective echocardiography use. These thresholds require prospective multicenter validation.