Myocardial injury and its association with venom-induced coagulopathy following Bothrops atrox snakebite envenomation.

BACKGOUND: In Brazil, the highest incidences of snakebite envenomation (SBE) occur in the Amazon region, caused mostly by Bothrops atrox. Among the effects of envenomation, cardiac alterations are not a frequent outcome but are highly linked to severe cases.

OBJECTIVE

The present study investigated the serum profile of cardiac injury markers (fatty acid binding protein 3 - H-FABP3, N-terminal type B natriuretic peptide - NTproBNP, creatine kinase-MB - CPK-MB, and troponin I) following Bothrops SBEs and their association with venom-induced coagulopathy.

METHODS

Plasma markers were evaluated from blood collected at admission (before antivenom - T0) and 48h after antivenom (T48) from 80 B. atrox SBE patients treated at a tertiary hospital in Manaus, Brazilian Amazon, and 20 healthy donors.

RESULTS

Markers were found increased, above reference range or compared to sex- and age-matched healthy controls, including FABP3 in at least 98.7% of patients, Troponin I 12.5%, and CK-MB in 8.8%. Regarding correlations to coagulation markers, alpha 2-antiplasmin concentrations were negatively correlated with FABP3 levels (T0), whereas FDP, tissue factor, and plasma factor VII levels were positively correlated with troponin I concentrations. Moreover, the group of patients with increased troponin I levels presented significantly higher FDP concentrations, factor VII levels, and risk for systemic bleeding at T0, whereas higher D-dimer concentrations at T48.

CONCLUSIONS

Our findings show that Bothrops SBE is responsible for myocardial injury, although not associated with severe outcomes, and its directly associated to venom-induced coagulopathy, indicating troponin-I and FABP3 as possible markers to screen patients for more detailed cardiac alterations.