Association Between High-Sensitivity Troponin (hs-cTnT) and Diagnosis of Myocarditis in Previously Healthy Pediatric
Michelle Degen1, Julie Leviter2, Allison Bradley3
1Section of Pediatric Cardiology, Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA. michellegdegen@gmail.com.
Insights
High-sensitivity troponin T (hs-cTnT) can help diagnose myocarditis in children. A hs-cTnT level of 90 ng/dL effectively identifies pediatric myocarditis cases with high accuracy.
Area of Science:
- Pediatric Cardiology
- Biomarkers
- Cardiac Diagnostics
Background:
- Cardiac troponin is a key biomarker for myocardial injury.
- Limited data exists on high-sensitivity troponin T (hs-cTnT) in pediatric populations.
- Clinical interpretation of hs-cTnT in children requires further investigation.
Purpose of the Study:
- To determine the association between hs-cTnT levels and myocarditis diagnosis in pediatric patients.
- To evaluate the utility of hs-cTnT in identifying acute myocarditis in children.
- To establish a potential diagnostic cut-off value for hs-cTnT in pediatric myocarditis.
Main Methods:
- Retrospective review of hs-cTnT levels in pediatric patients from February 2022 to February 2023.
- Comparison of demographic and clinical data between patients with elevated and non-elevated hs-cTnT.
- Analysis of hs-cTnT levels in patients diagnosed with myocarditis versus other conditions.
Main Results:
- Of 308 pediatric patients, 91 (29.5%) had elevated hs-cTnT.
- 8 patients (2.5%) were diagnosed with acute myocarditis.
- Median peak hs-cTnT levels were significantly higher in myocarditis patients (506.5 ng/L) compared to others (6.0 ng/L) (p < 0.001).
Conclusions:
- A hs-cTnT cut-off value of 90 ng/dL demonstrated 100% sensitivity and 95% specificity for diagnosing pediatric myocarditis.
- hs-cTnT is a valuable tool for the diagnosis of myocarditis in pediatric patients.
- Further research can refine the interpretation of hs-cTnT in pediatric cardiac conditions.
Abstract:
Cardiac troponin is commonly used to screen for cardiac diagnoses in pediatric patients, as it is only released by myocardial tissue. There is limited data regarding high-sensitivity troponin T in pediatric populations and its clinical interpretation. We sought to determine how high-sensitivity troponin values are associated with myocarditis diagnosis. High sensitivity troponin levels were reviewed for pediatric patients at our center from February 2022 to February 2023. Basic demographic and presenting data (including age, gender, body mass index), and diagnoses (cardiac diagnosis, including myocarditis, vs non-cardiac) were compared for patients with elevated initial troponin levels (≥ 12 ng/L) vs. those with non-elevated values. Of the 308 patients included, 91 (29.5%) had elevated hs-cTnT and 45 (14.6%) had a cardiac diagnosis, of whom 8 (2.5%) were ultimately diagnosed with acute myocarditis. There was no meaningful difference in demographic characteristics between the elevated and non-elevated hs-cTnT groups. For patients with diagnosis of myocarditis (n = 8), median peak levels were 506.5 ng/L (182.0 to 1184.0) versus 6.0 ng/L (< 6.0 to 13.5) for those with all other diagnoses (n = 300) (p < 0.001). A high sensitivity troponin cut-off value of 90 ng/dL was established for diagnosis of myocarditis, providing high sensitivity (100%) and specificity of (95%).
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