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Infants with congenital heart disease have elevated biochemical markers of brain injury prior to cardiac surgery
J. M. Simsic1, S. Dambinova2, G. Izykenova2, W. Mahle1, P. M. Kirshbom3, P. Bokesch3. 1Children's Healthcare of Atlanta, Atlanta, GA, 2Cis-Biotech, Atlanta, GA, 3Emory University, Atlanta, GA,
Background: During ischemia, N-Methyl-D-Aspartate (NMDA) receptor fragments appear in the bloodstream. Patients with CNS disorders develop autoantibodies to the receptor fragments. Purpose of this study was to observe the expression of the NMDA receptor fragment (NR2 peptide) and antibody (NR2 antibody) biomarker of brain ischemia in infants with congenital heart disease.
Methods: NR2 peptide and NR2 antibody was obtained in 13 infants undergoing cardiac surgery (study group) at 2 time points; (1) baseline; (2) 24 hours postop. Data obtained was compared to NR2 peptide and NR2 antibody in normal infants (n=4, control group).
Results: Average age 1.6±2.3 months, study group vs 2.7±2.1 months, control group. Operations included: TOF repair (3); ASO with VSD repair (1); ASO (1); CAVC repair (1); TOF/PA complete repair (1); TAPVR repair (1); hypoplastic arch repair (1); DCRV and VSD repair (1); coarctation repair and PAB (1); coarctation repair (1) Norwood (1). Baseline NR2 antibody levels were elevated in study group vs control group (p=0.002). See Table. | NR2 peptide ng/ml | NR2 antibody ng/ml | | Control Group, N=4 | 0.23±0.13 | 0.73±0.15 | Study Group
Baseline, N=13 | 1.33±2.36 | 1.25±0.44* | Study Group
24 hrs Postop, N=13 | 0.96±0.67# | 1.24±0.53# |
* p < 0.05; control group vs baseline congenital heart disease
# p < 0.05; control group vs 24 hour postop
2-tailed T-test
Conclusions: Infants with congenital heart disease have elevated NR2 antibody at baseline compared to normal infants. This supports speculation that infants with congenital heart disease have brain ischemia/injury prior to surgical intervention. Further study is warranted.
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