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What is the Significance of Elevated Troponin I in Children and Adolescents? A Diagnostic Approach

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Abstract

Troponin is a marker that displays cardiac injury quickly and accurately. In adults, troponin elevation is usually associated with coronary artery disease and requires urgent cardiac catheterization. In healthy children, myocardial injury is rare and may develop due to many different causes. Therefore, troponin elevation in children and adolescents does not usually require emergency cardiac catheterization. The aim of this study is to assess the most common causes of troponin elevation in children and adolescents and to show which diagnostic tests are helpful in assessing pediatric patients with elevated troponin. Patients who had been diagnosed with troponin I elevation (> 0.06 ng/ml) at Dr. Sami Ulus Maternity, Children's Health and Disease Training and Research Hospital between 2007 and 2018 were retrospectively evaluated. Patients undergoing cardiac surgery and those with severe congenital heart disease were excluded from the study. The medical records of the patients were examined and age, gender, diagnostic tests, and diagnosis were evaluated. During the study period, the records of 972 patients were obtained. 213 patients were excluded from the study because of heart surgery, congenital heart disease, and neonatal asphyxia or sepsis. Of the remaining 759 patients, 58% were male, 42% were female, and the median age was 4 years (3 days to 17 years). The most frequent causes are myopericarditis (n: 164), drug intoxications (n: 85), carbon monoxide poisoning (n: 74), perimyocarditis (n: 65), and intensive inhalation β agonist use in acute asthma and lower respiratory tract infections (n: 70). Patients diagnosed with myocarditis and myopericarditis were admitted with a complaint of chest pain, and the diagnosis was made by history, physical examination, ECG, and echocardiographic findings. Unlike adults, troponin I elevation may be associated with many cardiac and non-cardiac pathologies in children. The most common pathologies in cardiac etiology are myopericarditis and perimyocarditis and can be diagnosed by history, physical examination, ECG, and echocardiography. Cardiac catheterization is not necessary except for rare cardiac pathologies and does not alter the prognosis.

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Authors and Affiliations

  1. Department of Pediatric Cardiology, Dr. Sami Ulus Maternity, Children’s Health and Diseases Training and Research Hospital, Ankara, Turkey

    Tamer Yoldaş & Utku Arman Örün

  2. Department of Cardiology, Dr. Sami Ulus Maternity, Children’s Health and Diseases Training and Research Hospital, Babür Caddesi Number:44, Altındağ, 06080, Ankara, Turkey

    Tamer Yoldaş

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Correspondence to Tamer Yoldaş.

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Tamer Yoldaş and Utku Arman Örün declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Yoldaş, T., Örün, U.A. What is the Significance of Elevated Troponin I in Children and Adolescents? A Diagnostic Approach. Pediatr Cardiol 40, 1638–1644 (2019). https://doi.org/10.1007/s00246-019-02198-w

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