Current and Future Indication for Testing and Use of Cardiac Troponin in Children
Kristin M Aakre1,2, Aamir Jeewa3, Louise Cullen4,5
1Department of Medical Biochemistry and Pharmacology and Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
Insights
Cardiac troponin (cTn) interpretation in children is inconsistent. Current data show high cTn levels in newborns, decreasing with age, with low myocardial injury incidence. More research is needed for pediatric cTn testing.
Area of Science:
- Pediatric Cardiology
- Clinical Chemistry
- Biomarker Research
Background:
- Clinical use and interpretation of cardiac troponins (cTn) in pediatric patients are highly variable.
- Existing literature and expert discussions highlight the need for standardized practices in pediatric cTn testing.
Purpose of the Study:
- To summarize current knowledge and best practices for cTn measurements in pediatric patients.
- To discuss appropriate upper reference limits, age- and sex-related concentration influences, and preanalytical/analytical considerations.
- To provide consensus on optimal interpretation of pediatric cTn results.
Main Methods:
- Literature appraisal and synthesis.
- Discussions among international committee members, pediatricians, cardiologists, emergency physicians, and laboratorians.
Main Results:
- Healthy infants and newborns exhibit high cTn concentrations, with levels decreasing until age 1-3 years and rising to adult levels by puberty.
- The incidence of myocardial injury is low and depends on the chosen upper reference limit (97.5th or 99th percentile).
- Primary indications for cTn testing include suspected myo/pericarditis or traumatic chest injury; testing for heart failure/ischemia is less common.
Conclusions:
- Current pediatric cTn data are limited, often retrospective, and largely based on expert opinion.
- Heterogeneity exists in published clinical studies regarding cTn interpretation.
- Further research is essential across all aspects of pediatric cTn testing to establish evidence-based guidelines.
Background:
The clinical use and interpretation of cardiac troponins (cTn) in pediatric patients is heterogeneous.
Content:
This review is based on an appraisal and synthesis of the available literature and discussions between International Federation of Clinical Chemistry and Laboratory Medicine Committee on Clinical Application of Cardiac Biomarkers members and pediatricians, cardiologists, emergency department physicians, and laboratorians. It aims to summarize current knowledge and best practices related to cTn measurements in pediatric patients, including which percentile should be applicable as the upper reference limit, and the influence of age, sex, and physiology on circulating concentrations. Preanalytical and analytical precautions, and a consensus on optimal interpretation of the reported results are discussed.
Summary:
Current studies report high cTn concentrations in healthy infants and newborns. The nadir is reached at 1-3 years at which time concentrations gradually increase, reaching adult levels through puberty. The incidence of myocardial injury is reported to be low and dependent on whether the 97.5th or 99th percentile is chosen as the upper reference limit. The main clinical indication for testing appears to be suspicion of myo/pericarditis or traumatic chest injury. On occasion, cTn is measured in cases of possible heart failure and/or myocardial ischemia. There is heterogeneity among the limited clinical studies published. Most of the data are retrospective, and the current suggestions for clinical practice are thus largely based on expert opinion. More research is needed regarding all aspects of cTn testing in children, and suggestions for future research are included at the end of this review.
Related Concept Videos
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:28Imaging Studies for Cardiovascular System V: CT
01:19Blood Studies for Cardiovascular System II: CRP, Hcy, and Cardiac Natriuretic Peptide Markers
These markers indicate stress or strain on the heart muscle:
Natriuretic Peptides (BNP)
Cardiac myocytes produce these hormones in response to ventricular stretching...
01:30Dysrhythmias V: Evaluating Dysrhythmias
01:27Myocarditis II: Clinical Features and Diagnostic Tests