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.
Troponin Myocarditis ECMO Pediatric Mortality
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The authors declare that they have no conflict of interest.
Di Filippo S (2016) Improving outcomes of acute myocarditis in children. Expert Rev Cardiovasc Ther 14(1):117–125CrossRefPubMedGoogle Scholar
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
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
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
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
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
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
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
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
Abrar S, Ansari MJ, Mittal M, Kushwaha KP (2016) Predictors of mortality in paediatric myocarditis. J Clin Diagn Res 10(6):SC12-16Google Scholar
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
Kindermann I, Kindermann M, Kandolf R et al (2008) Predictors of outcome in patients with suspected myocarditis. Circulation 118(6):639–648CrossRefPubMedGoogle Scholar