Blood Markers of Cardiac Stress After Generalized Convulsive Seizures. Nass RD, Motloch LJ, Paar V, Lichtenauer M, Baumann J, Zur B, Hoppe UC, Holdenrieder S, Elger CE, Surges R. Epilepsia. 2019;60(2):201-210. doi:10.1111/epi.14637. Epub 2019 Jan 15. PMID: 30645779 Objective: Generalized convulsive seizures (GCS) are associated with high demands on the cardiovascular system, thereby facilitating cardiac complications. To investigate occurrence, influencing factors, and extent of cardiac stress or injury, the alterations and time course of the latest generation of cardiac blood markers were investigated after documented GCS. METHODS Adult patients with refractory epilepsy who underwent video-electroencephalography monitoring along with simultaneous one-lead electrocardiography recordings were included. Cardiac biomarkers (cardiac troponin I [cTNI]; high-sensitivity troponin T [hsTNT]; N-terminal prohormone of brain natriuretic peptide; copeptin; suppression of tumorigenicity-2 [SST-2]; growth differentiation factor 15, [GDF-15]; soluble urokinase plasminogen activator receptor [suPAR]; and heart-type fatty acid binding protein [HFABP]) and catecholamines were measured at inclusion and at different time points after GCS. Peri-ictal cardiac properties were assessed by analyzing heart rate (HR), HR variability (HRV), and corrected QT intervals (QTc). RESULTS Thirty-six GCS (6 generalized-onset tonic-clonic seizures and 30 focal to bilateral tonic-clonic seizures) were recorded in 30 patients without a history of cardiac or renal disease. Postictal catecholamine levels were elevated more than 2-fold. A concomitant increase in HR and QTc, as well as a decrease in HRV, was observed. Elevations of cTNI and hsTNT were found in 3 (10%) of 30 patients and 6 (26%) of 23 patients, respectively, which were associated with higher dopamine levels. Copeptin was increased considerably after most GCS, whereas SST-2, HFABP, and GDF-15 displayed only subtle variations, and suPAR was unaltered in the postictal period. Cardiac symptoms did not occur in any patient. SIGNIFICANCE The use of more sensitive biomarkers such as hsTNT suggests that signs of cardiac stress occur in about 25% of the patients with GCS without apparent clinical symptoms. Soluble urokinase plasminogen activator receptor may indicate clinically relevant troponin elevations. Copeptin could help to diagnose GCS but specificity needs to be tested.

中文翻译：

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单纯性全身惊厥性癫痫发作后的令人心碎的心脏压力。

全身性惊厥性癫痫发作后心脏应激的血液标志物。纳斯RD，莫特洛赫LJ，帕尔五世，利希特瑙尔M，鲍曼J，祖尔B，霍普UC，霍顿里德S，埃尔格CE，瑟吉斯R. 2019; 60（2）：201-210。doi：10.1111 / epi.14637。Epub 2019 1月15日。PMID：30645779目的：全身性惊厥性癫痫发作（GCS）与对心血管系统的高需求相关，从而促进心脏并发症。为了研究心脏压力或损伤的发生，影响因素和程度，在记录了GCS之后，研究了最新一代心脏血液标志物的变化和时程。方法包括成人难治性癫痫患者，他们接受视频脑电图监测并同时记录一导心电图。心脏生物标志物（心脏肌钙蛋白I [cTNI]；高敏感性肌钙蛋白T [hsTNT]；脑钠肽的N端激素原；肽素 抑制致瘤性2 [SST-2]；生长分化因子15，[GDF-15]；可溶性尿激酶纤溶酶原激活物受体[suPAR]；和心脏型脂肪酸结合蛋白（HFABP））和儿茶酚胺在GCS入选后和不同时间点进行测量。通过分析心率（HR），HR变异性（HRV）和校正的QT间隔（QTc）评估围手术期心脏的特性。结果在30例无心脏病或肾脏病史的患者中，共记录了36例GCS（6例全身发作的强直性阵挛性癫痫发作和30例局部至双侧强直性阵挛性发作）。术后儿茶酚胺水平升高超过2倍。观察到HR和QTc的同时升高，HRV降低。30例患者中有3例（10％）和23例患者中有6例（26％）发现cTNI和hsTNT升高，这与多巴胺水平升高有关。在大多数GCS后，copeptin显着增加，而SST-2，HFABP和GDF-15仅表现出细微的变化，而suPAR在发作期未改变。任何患者均未出现心脏症状。意义使用更敏感的生物标志物，例如hsTNT，表明大约25％的GCS患者出现心脏压力征象，而没有明显的临床症状。可溶性尿激酶纤溶酶原激活剂受体可能表明临床相关的肌钙蛋白升高。Copeptin可以帮助诊断GCS，但需要测试特异性。与多巴胺水平升高有关。大多数GCS后，copeptin均显着增加，而SST-2，HFABP和GDF-15仅表现出细微的变化，而suPAR在发作期未改变。任何患者均未出现心脏症状。意义使用更敏感的生物标志物，例如hsTNT，表明大约25％的GCS患者出现心脏压力征象，而没有明显的临床症状。可溶性尿激酶纤溶酶原激活剂受体可能表明临床相关的肌钙蛋白升高。Copeptin可以帮助诊断GCS，但需要测试特异性。与多巴胺水平升高有关。大多数GCS后，copeptin均显着增加，而SST-2，HFABP和GDF-15仅表现出细微的变化，而suPAR在发作期未改变。任何患者均未出现心脏症状。意义使用更敏感的生物标志物，例如hsTNT，表明大约25％的GCS患者出现心脏压力征象，而没有明显的临床症状。可溶性尿激酶纤溶酶原激活剂受体可能表明临床相关的肌钙蛋白升高。Copeptin可以帮助诊断GCS，但需要测试特异性。意义使用更敏感的生物标志物，例如hsTNT，表明大约25％的GCS患者出现心脏压力征象，而没有明显的临床症状。可溶性尿激酶纤溶酶原激活剂受体可能表明临床相关的肌钙蛋白升高。Copeptin可以帮助诊断GCS，但需要测试特异性。意义使用更敏感的生物标志物，例如hsTNT，表明大约25％的GCS患者出现心脏压力征象，而没有明显的临床症状。可溶性尿激酶纤溶酶原激活剂受体可能表明临床相关的肌钙蛋白升高。Copeptin可以帮助诊断GCS，但需要测试特异性。