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Evaluation of conventional troponin I testing for the detection of myocardial dysfunction in children

Eimear McGovern1, Christine Voss1, Nicole M Hemphill1

  • 1Division of Cardiology, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, British Columbia.

Paediatrics & Child Health
|November 16, 2022
PubMed

Insights

Troponin I testing in children shows low sensitivity for detecting myocardial dysfunction, indicating limited utility as a screening tool for myocardial injury in this population.

Area of Science:

  • Pediatric Cardiology
  • Biomarkers in Cardiovascular Disease
  • Pediatric Critical Care Medicine

Background:

  • Troponin is a key biomarker for myocardial injury, but its role in pediatric populations is not extensively studied.
  • Assessing myocardial dysfunction in children requires accurate diagnostic tools.

Purpose of the Study:

  • To determine the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of troponin I for detecting acute myocardial dysfunction in previously healthy children.
  • To identify clinical predictors of myocardial dysfunction in pediatric patients with elevated troponin levels.

Main Methods:

  • A retrospective chart review was conducted at a single pediatric tertiary care center over a 4-year period.
  • Data collected included demographics, symptoms, clinical signs, chest X-ray, ECG, and echocardiogram findings for all admitted children who underwent troponin testing.
  • Myocardial dysfunction was defined based on cardiac assessment, echocardiography, and patient re-presentation.

Main Results:

  • Of 566 children tested, troponin was elevated in 6.7% (38 cases), and myocardial dysfunction was detected in 1.6% (9 cases).
  • Troponin I demonstrated a sensitivity of 66% and a specificity of 94% for detecting myocardial dysfunction.
  • The positive predictive value (PPV) was 16%, and the negative predictive value (NPV) was 99%. An abnormal ECG was associated with true positive troponin results.

Conclusions:

  • Troponin I testing identified a small number of pediatric myocardial dysfunction cases, with a sensitivity of 66%.
  • The low sensitivity and PPV suggest that troponin testing has limited utility as a routine screen for myocardial injury in children.
  • Further research may be needed to explore alternative biomarkers or diagnostic strategies for pediatric myocardial dysfunction.
Abstract

Keywords:
Myocardial injuryMyocarditisPaediatricsScreening

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