Advertisement

Pediatric Cardiology

, Volume 39, Issue 6, pp 1139–1143 | Cite as

Elevated Troponin in the First 72 h of Hospitalization for Pediatric Viral Myocarditis is Associated with ECMO: An Analysis of the PHIS+ Database

  • Arene Butto
  • Joseph W. Rossano
  • Deipanjan Nandi
  • Chitra Ravishankar
  • Kimberly Y. Lin
  • Matthew J. O’Connor
  • Robert E. Shaddy
  • Pirouz Shamszad
Original Article

Abstract

Serum troponin (Tn) is often elevated in viral myocarditis; however, its prognostic significance is unknown. We tested the hypothesis that abnormal serum Tn is associated with mortality in children hospitalized with myocarditis. We retrospectively studied data from six large children’s hospitals participating in the Pediatric Health Information System Plus (PHIS+) database. Analysis was performed on patients hospitalized with viral myocarditis between 2007 and 2013, in whom at least one Tn was recorded within 72 h of admission. Abnormal baseline Tn was defined as any value outside the upper limit of normal within the first 72 h. Primary outcome was mortality. Secondary outcomes included mechanical support, defined as use of extracorporeal membrane oxygenation (ECMO) or a ventricular assist device (VAD), cardiac transplantation, intravenous immunoglobulin (IVIg), mechanical ventilation, and inotrope use. A total of 149 patients with myocarditis (61% male, 48% adolescents) across all PHIS+ centers had TnI (n = 113) or TnT (n = 36) recorded. At least one abnormal Tn was present in 81% of cases. Overall mortality was 7.3% and was not associated with abnormal baseline Tn. Abnormal baseline Tn was associated with ECMO (7.1 vs. 25.6%, p = 0.03) and IVIg (46.4 vs. 83.5%, p < 0.001). Abnormal baseline Tn was not associated with transplantation, mechanical ventilation or inotrope use. Abnormal Tn in the first 72 h of hospitalization for myocarditis was associated with the use of ECMO and IVIg, but was not associated with mortality. This finding may help risk stratify this population if it can be prospectively validated.

Keywords

Troponin Myocarditis ECMO Pediatric Mortality 

Notes

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Di Filippo S (2016) Improving outcomes of acute myocarditis in children. Expert Rev Cardiovasc Ther 14(1):117–125CrossRefPubMedGoogle Scholar
  2. 2.
    Imazio M, Brucato A, Barbieri A et al (2013) Good prognosis for pericarditis with and without myocardial involvement: results from a multicenter, prospective cohort study. Circulation 128(1):42–49CrossRefPubMedGoogle Scholar
  3. 3.
    Sachdeva S, Song X, Dham N, Heath DM, DeBiasi RL (2015) Analysis of clinical parameters and cardiac magnetic resonance imaging as predictors of outcome in pediatric myocarditis. Am J Cardiol 115(4):499–504CrossRefPubMedGoogle Scholar
  4. 4.
    Kobayashi D, Aggarwal S, Kheiwa A, Shah N (2012) Myopericarditis in children: elevated troponin I level does not predict outcome. Pediatr Cardiol 33(7):1040–1045CrossRefPubMedGoogle Scholar
  5. 5.
    Casadonte JR, Mazwi ML, Gambetta KE et al (2017) Risk factors for cardiac arrest or mechanical circulatory support in children with fulminant myocarditis. Pediatr Cardiol 38(1):128–134CrossRefPubMedGoogle Scholar
  6. 6.
    Klugman D, Berger JT, Sable CA, He J, Khandelwal SG, Slonim AD (2010) Pediatric patients hospitalized with myocarditis: a multi-institutional analysis. Pediatr Cardiol 31(2):222–228CrossRefPubMedGoogle Scholar
  7. 7.
    Imazio M, Brucato A, Spodick DH, Adler Y (2014) Prognosis of myopericarditis as determined from previously published reports. J Cardiovasc Med 15(12):835–839CrossRefGoogle Scholar
  8. 8.
    Ghelani SJ, Spaeder MC, Pastor W, Spurney CF, Klugman D (2012) Demographics, trends, and outcomes in pediatric acute myocarditis in the United States, 2006 to 2011. Circ Cardiovasc Qual Outcomes 5(5):622–627CrossRefPubMedGoogle Scholar
  9. 9.
    Schwartz MC, Wellen S, Rome JJ, Ravishankar C, Natarajan S (2013) Chest pain with elevated troponin assay in adolescents. Cardiol Young 23(3):353–360CrossRefPubMedGoogle Scholar
  10. 10.
    Abrar S, Ansari MJ, Mittal M, Kushwaha KP (2016) Predictors of mortality in paediatric myocarditis. J Clin Diagn Res 10(6):SC12-16Google Scholar
  11. 11.
    Teele SA, Allan CK, Laussen PC, Newburger JW, Gauvreau K, Thiagarajan RR (2011) Management and outcomes in pediatric patients presenting with acute fulminant myocarditis. J Pediatr 158(4):638–643 e631CrossRefPubMedGoogle Scholar
  12. 12.
    Kindermann I, Kindermann M, Kandolf R et al (2008) Predictors of outcome in patients with suspected myocarditis. Circulation 118(6):639–648CrossRefPubMedGoogle Scholar
  13. 13.
    Fuse KK (2000) Predictors of disease course in patients with acute myocarditis. Circulation 102(23):2829–2835CrossRefPubMedGoogle Scholar
  14. 14.
    Eisenberg MAMA (2012) Cardiac troponin T as a screening test for myocarditis in children. Pediatr Emerg Care 28(11):1173–1178CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of CardiologyChildren’s Hospital of PhiladelphiaPhiladelphiaUSA
  2. 2.Division of Cardiology, The Heart CenterNationwide Children’s HospitalColumbusUSA

Personalised recommendations