Advertisement

Pediatric Cardiology

, Volume 37, Issue 2, pp 392–398 | Cite as

Characterization of Cardiac Troponin Elevation in the Setting of Pediatric Supraventricular Tachycardia

  • Jeremy P. MooreEmail author
  • Lisa Arcilla
  • Shuo Wang
  • Michael S. Lee
  • Kevin M. Shannon
Original Article

Abstract

Cardiac troponin (cTn) is currently considered the gold standard biomarker for detection of myocardial necrosis. Patients with supraventricular tachycardia (SVT) often present with symptoms resulting in cTn assessment; however, there are no data on the results of such testing in childhood. We hypothesized that cTn elevation would be common in the pediatric SVT population and would portend a benign prognosis. A retrospective review of all pediatric patients (≤21 years) presenting with SVT was performed. Clinical and electrocardiographic variables from the emergency department (ED) presentation were reviewed and clinical outcomes during subsequent follow-up assessed. Of 128 patients seen in the ED for SVT, cTn was assessed in 48 (38 %). Of patients with cTn assessment, 14 (29 %) patients demonstrated cTn elevation. Univariate predictors of cTn elevation included presentation with respiratory or gastrointestinal symptoms (50 vs 12 % and 42 vs 9 %; p = 0.008 and p = 0.01, respectively), lower mean arterial blood pressure (73 vs 85 mm Hg, p = 0.009), higher age-adjusted tachycardia rate (z score 9.3 vs 7.2, p < 0.001), and longer tachycardia duration (4.2 vs 1.0 h, p = 0.02). Multivariate logistic regression confirmed the association of age-adjusted tachycardia rate (odds ratio [OR] 3.8 per heart rate z score, confidence interval [CI] 1.9–11.8, p = 0.003) and duration (OR 1.5 per hour, CI 1.1–2.5, p = 0.03). Clinical outcome was excellent with no adverse sequelae during a median of 2.9 years of follow-up. Cardiac Tn elevation is common in the pediatric population presenting with SVT. Episode severity, characterized by respiratory or gastrointestinal symptoms, lower mean blood pressure, and increased tachycardia rate and duration are predictive. Clinical follow-up is favorable.

Keywords

Cardiac troponin Electrocardiogram Pediatrics Supraventricular tachycardia 

Abbreviations

CAD

Coronary artery disease

cTn

Cardiac troponin

ECG

Electrocardiogram

OR

Odds ratio

SVT

Supraventricular tachycardia

Notes

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Amsterdam EA, Wenger NK, Brindis RG, Casey DE Jr, Ganiats TG, Holmes DR Jr, Jaffe AS, Jneid H, Kelly RF, Kontos MC, Levine GN, Liebson PR, Mukherjee D, Peterson ED, Sabatine MS, Smalling RW, Zieman SJ, Members AATF (2014) 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 130:2354–2394CrossRefPubMedGoogle Scholar
  2. 2.
    Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE Jr, Chavey WE II, Fesmire FM, Hochman JS, Levin TN, Lincoff AM, Peterson ED, Theroux P, Wenger NK, Wright RS, Smith SC Jr, Jacobs AK, Adams CD, Anderson JL, Antman EM, Halperin JL, Hunt SA, Krumholz HM, Kushner FG, Lytle BW, Nishimura R, Ornato JP, Page RL, Riegel B, American College of C, American Heart Association Task Force on Practice G, American College of Emergency P, Society for Cardiovascular A, Interventions, Society of Thoracic S, American Association of C, Pulmonary R, Society for Academic Emergency M (2007) ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-Elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine. J Am Coll Cardiol 50:e1–e157Google Scholar
  3. 3.
    Antman E, Bassand J-P, Klein W, Ohman M, Lopez Sendon JL, Rydén L, Simoons M, Tendera M (2000) Myocardial infarction redefined—a consensus document of The Joint European Society of Cardiology/American College of Cardiology committee for the redefinition of myocardial infarction. J Am Coll Cardiol 36:959–969CrossRefPubMedGoogle Scholar
  4. 4.
    Bakshi TK, Choo MKF, Edwards CC, Scott AG, Hart HH, Armstrong GP (2002) Causes of elevated troponin I with a normal coronary angiogram. Intern Med J 32:520–525CrossRefPubMedGoogle Scholar
  5. 5.
    Bukkapatnam RN, Robinson M, Turnipseed S, Tancredi D, Amsterdam E, Srivatsa UN (2010) Relationship of myocardial ischemia and injury to coronary artery disease in patients with supraventricular tachycardia. Am J Cardiol 106:374–377CrossRefPubMedGoogle Scholar
  6. 6.
    Carlberg DJ, Tsuchitani S, Barlotta KS, Brady WJ (2011) Serum troponin testing in patients with paroxysmal supraventricular tachycardia: outcome after ED care. Am J Emerg Med 29:545–548CrossRefPubMedGoogle Scholar
  7. 7.
    Chow GV, Hirsch GA, Spragg DD, Cai JX, Cheng A, Ziegelstein RC, Marine JE (2010) Prognostic significance of cardiac troponin I levels in hospitalized patients presenting with supraventricular tachycardia. Medicine (Baltimore) 89:141–148CrossRefGoogle Scholar
  8. 8.
    Claessen G, Claus P, Ghysels S, Vermeersch P, Dymarkowski S, La Gerche A, Heidbuchel H (2014) Right ventricular fatigue developing during endurance exercise: an exercise cardiac magnetic resonance study. Med Sci Sports Exerc 46:1717–1726CrossRefPubMedGoogle Scholar
  9. 9.
    Corday E, Gold H, De Vera LB, Williams JH, Fields J (1959) Effect of the cardiac arrhythmias on the coronary circulation. Ann Intern Med 50:535–553CrossRefPubMedGoogle Scholar
  10. 10.
    Czapla C, Bernard A, Khandelwal S (2010) Best evidence topic report. BET 1. Are troponin levels indicated for the routine management of SVT? Emerg Med J 27:141–142PubMedGoogle Scholar
  11. 11.
    Davignon A, Rautaharju P, Boisselle E, Soumis F, Megelas M, Choquette A (1980) Normal Ecg standards for infants and children. Pediatr Cardiol 1:123–131CrossRefGoogle Scholar
  12. 12.
    Durani Y, Egan M, Baffa J, Selbst SM, Nager AL (2009) Pediatric myocarditis: presenting clinical characteristics. Am J Emerg Med 27:942–947CrossRefPubMedGoogle Scholar
  13. 13.
    Folke M, Cernerud L, Ekstrom M, Hok B (2003) Critical review of non-invasive respiratory monitoring in medical care. Med Biol Eng Comput 41:377–383CrossRefPubMedGoogle Scholar
  14. 14.
    Hessel MH, Atsma DE, van der Valk EJ, Bax WH, Schalij MJ, van der Laarse A (2008) Release of cardiac troponin I from viable cardiomyocytes is mediated by integrin stimulation. Pflugers Arch 455:979–986PubMedCentralCrossRefPubMedGoogle Scholar
  15. 15.
    Keane JF, Nadas AS, Plauth WH (1972) Chronic ectopic tachycardia of infancy and childhood. Am Heart J 84:748–757CrossRefGoogle Scholar
  16. 16.
    Middleton N, George K, Whyte G, Gaze D, Collinson P, Shave R (2008) Cardiac troponin T release is stimulated by endurance exercise in healthy humans. J Am Coll Cardiol 52:1813–1814CrossRefPubMedGoogle Scholar
  17. 17.
    Montgomery C, Hamilton N, Ianuzzo CD (1992) Energy status of the rapidly paced canine myocardium in congestive heart failure. J Appl Physiol 73:2363–2367PubMedGoogle Scholar
  18. 18.
    Petsas AA, Anastassiades LC, Antonopoulos AG (1990) Exercise testing for assessment of the significance of ST segment depression observed during episodes of paroxysmal supraventricular tachycardia. Eur Heart J 11:974–979PubMedGoogle Scholar
  19. 19.
    Redfearn DP, Ratib K, Marshall HJ, Griffith MJ (2005) Supraventricular tachycardia promotes release of troponin I in patients with normal coronary arteries. Int J Cardiol 102:521–522CrossRefPubMedGoogle Scholar
  20. 20.
    Robinson MR, Brown RA, Srivatsa U, Amsterdam EA (2007) Over the speed limit. Am J Med 120:851–853CrossRefPubMedGoogle Scholar
  21. 21.
    Schueler M, Vafaie M, Becker R, Biener M, Thomas D, Mueller M, Giannitsis E, Katus HA (2012) Prevalence, kinetic changes and possible reasons of elevated cardiac troponin T in patients with AV nodal re-entrant tachycardia. Acute Card Care 14:131–137CrossRefPubMedGoogle Scholar
  22. 22.
    Turer AT, Addo TA, Martin JL, Sabatine MS, Lewis GD, Gerszten RE, Keeley EC, Cigarroa JE, Lange RA, Hillis LD, de Lemos JA (2011) Myocardial ischemia induced by rapid atrial pacing causes troponin T release detectable by a highly sensitive assay: insights from a coronary sinus sampling study. J Am Coll Cardiol 57:2398–2405PubMedCentralCrossRefPubMedGoogle Scholar
  23. 23.
    Wilson JR, Douglas P, Hickey WF, Lanoce V, Ferraro N, Muhammad A, Reichek N (1987) Experimental congestive heart failure produced by rapid ventricular pacing in the dog: cardiac effects. Circulation 75:857–867CrossRefPubMedGoogle Scholar
  24. 24.
    Yedder NB, Roux JF, Paredes FA (2011) Troponin elevation in supraventricular tachycardia: primary dependence on heart rate. Can J Cardiol 27:105–109CrossRefPubMedGoogle Scholar
  25. 25.
    Zellweger MJ, Schaer BA, Cron TA, Pfisterer ME, Osswald S (2003) Elevated troponin levels in absence of coronary artery disease after supraventricular tachycardia. Swiss Med Wkly 133:439–441PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Jeremy P. Moore
    • 1
    Email author
  • Lisa Arcilla
    • 1
  • Shuo Wang
    • 1
  • Michael S. Lee
    • 2
  • Kevin M. Shannon
    • 1
  1. 1.Division of Cardiology, Department of PediatricsUCLA Medical CenterLos AngelesUSA
  2. 2.Division of Cardiology, Department of MedicineUCLA Medical CenterLos AngelesUSA

Personalised recommendations