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Elevations of troponin I after interventional cardiac catheterization
P J Kannankeril1, D F Wax, E Pahl
1Division of Cardiology, Children's Memorial Hospital, Chicago, Illinois 60614-3394, USA. pkannank@childrensmemorial.org
Insights
Cardiac catheterization in children significantly increases serum cardiac troponin I levels, a marker of heart muscle injury. These elevations are evident immediately after the procedure and persist for at least six hours.
Area of Science:
- Pediatric Cardiology
- Biomarkers of Cardiac Injury
- Interventional Cardiology
Background:
- Cardiac troponin I (cTnI) is a specific serum marker for myocardial injury.
- Cardiac catheterization is a common procedure in pediatric patients.
- The potential for cTnI elevation post-procedure in children is not well-established.
Purpose of the Study:
- To determine if cardiac catheterization is associated with an increase in serum cardiac troponin I levels in children.
- To assess the temporal pattern of cTnI elevation after cardiac catheterization.
Main Methods:
- Serum samples collected from pediatric patients (<21 years) before, immediately after, and six hours post-cardiac catheterization.
- Cardiac troponin I levels measured using the Abbott AxSYM microparticle immunoassay.
- Patients with elevated baseline cTnI were excluded; normal levels defined as 0-0.4 ng/ml.
Main Results:
- Elevated serum cTnI levels observed in 79% of patients immediately after catheterization (p < 0.0001).
- Elevations persisted, with 86% showing elevated cTnI six hours post-procedure (p < 0.0001).
- Only two patients experienced complications potentially causing myocardial injury.
Conclusions:
- Cardiac catheterization is associated with a high proportion of serum cTnI elevations in children.
- These cTnI elevations are detectable immediately and sustained for at least six hours post-procedure.
- The findings suggest cardiac catheterization, particularly interventions, can cause myocardial injury even without overt complications.
Background:
Elevation of cardiac troponin I in the serum is a specific marker for myocardial injury. We measured levels of troponin I in the serum in children before and after cardiac catheterization to determine if this procedure was associated with an increase in levels of troponin.
Methods:
We enrolled patients under 21 years of age undergoing cardiac catheterization at our institution. A baseline sample of serum was drawn at the start of the procedure. Repeat samples were obtained immediately after, and six hours subsequent to the procedure. All samples were analyzed for cardiac troponin I using the Abbott AxSYM microparticle immunoassay system. Levels were considered normal (0-0.4 ng/ml) or elevated (>0.4 ng/ml). Patients were excluded if the baseline level was elevated.
Results:
Levels of cardiac troponin I were elevated in the serum from 11 of 14 (79%) cases immediately after the procedure (p < 0.0001), and in 12 of 14 (86%) six hours later (p < 0.0001). Only 2 patients had recognized complications potentially causing myocardial injury.
Conclusion:
Levels of cardiac troponin I increase in the serum in a high proportion of children after cardiac catheterization. These elevations can be observed immediately, and are maintained for at least six hours. Our study suggests that cardiac catheterization, predominantly intervention, is associated with myocardial injury, even in the absence of complications.