Marcadores de Lesão Cardíaca em pacientes vítimas de envenenamento botrópico

Abstract

In Brazil, snake envenomations are more prevalent in the Amazon region, characterized by remote areas with difficult access, which hinders adequate treatment and exacerbates the severity of envenomation. Snake venom toxins, such as metalloproteinases, cause acute muscle cell injury by interfering with coagulation factors and platelet function. In addition to metalloproteinases, phospholipases also play a crucial role in cardiac injuries by degrading phospholipids in cell membranes, leading to cell rupture and death of cardiac muscle cells, which can further aggravate cardiac damage in envenomation cases. The aim of this study was to describe the levels of cardiac injury markers: heart-type fatty acid-binding protein (FABP3), creatine kinase MB (CK-MB), B-type natriuretic peptide (NTproBNP), and troponin I in Bothrops atrox envenomation. The observational study was conducted with 80 patients who suffered B. atrox envenomation treated at a reference hospital in Manaus, in the Brazilian Amazon. Patients were evaluated at T0 (before antivenom administration) and T48 (48 hours after), with samples processed in duplicate for the detection and measurement of circulating cardiac enzymes using cardiovascular biomarkers. The study included 80 patients with Bothrops envenomation and 20 healthy donors as the control group. Results showed that hemostasis parameters were altered upon admission (T0) but returned to normal at 48 hours (T48). The FABP3 biomarker was significantly elevated at T0 (P<0.001), decreasing at T48. In the correlation between cardiac and hemostasis markers at T0, alpha 2-antiplasmin was negatively correlated with FABP3 (P=0.017), while FDP (P=0.051), tissue factor (P=0.022), and factor VII were positively correlated with troponin I (P=0.008), and factor X was negatively correlated with CKMB (P=0.045). Only FABP3 was positively correlated with Bothrops venom serum levels at T0 (P=0.040) and T48 (P=0.034). These preliminary results indicate a significant association between coagulopathy induced by Bothrops envenomation and cardiac injury. We conclude that monitoring cardiac biomarkers is crucial for assessing the risk of cardiac injury in affected patients, which may contribute to more effective and targeted clinical management.