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Comparison of troponin-I and troponin-T after pediatric cardiovascular operation
F F Immer1, F P Stocker, A M Seiler
1Department of Clinical Chemistry, University Hospital, Berne, Switzerland.
Insights
Troponin-I is a reliable marker for detecting perioperative myocardial damage in children, performing similarly to troponin-T. Unlike troponin-T, troponin-I is unaffected by renal failure, offering a distinct diagnostic advantage.
Area of Science:
- Pediatric Cardiology
- Biomarkers
- Cardiac Surgery
Background:
- Troponin-T is a known diagnostic marker for myocardial damage in children.
- The significance of troponin-I in pediatric cardiac surgery remains less understood.
- Assessing perioperative myocardial damage is crucial in pediatric cardiac procedures.
Purpose of the Study:
- To compare the diagnostic value of troponin-I and troponin-T in children undergoing cardiac operations.
- To evaluate the potential of troponin-I and troponin-T in detecting perioperative myocardial damage.
- To determine if troponin-I offers advantages over troponin-T in specific pediatric patient populations.
Main Methods:
- Prospective enrollment of 48 children undergoing cardiac operations (age range: 1 day to 204 months).
- Measurement of troponin-I, troponin-T, creatine kinase (CK), and CK-MB isoenzyme before and within 2 days post-operation.
- Categorization of surgical approaches: extracardiac, right atrial interventions, and atrial/ventricular surgical approaches.
Main Results:
- Troponin-I levels remained within the normal range for extracardiac operations.
- Significant increases in troponin-I were observed following right atrial interventions and combined atrial/ventricular approaches (p<0.01).
- Troponin-I demonstrated equal specificity and sensitivity to troponin-T, except in cases of postoperative renal failure where troponin-T yielded false positives.
Conclusions:
- Troponin-I is a specific marker for perioperative myocardial damage, outperforming CK-MB activity and mass.
- The diagnostic utility of troponin-I is comparable to troponin-T in pediatric cardiac surgery.
- Troponin-I offers a significant advantage over troponin-T by not being falsely elevated in patients with renal failure.
Background:
Although the diagnostic value of troponin-T in childhood is documented, little is known about the significance of troponin-I. It was the aim of this study to compare the diagnostic value of troponin-I and troponin-T in children and newborns to assess the perioperative potential myocardial damage.
Methods:
Forty-eight children, mean, 51+/-54 months (mean value +/-1 standard deviation) (range, 1 day to 204 months) undergoing cardiac operation were prospectively enrolled in the present study. Troponin-I, troponin-T, creatine kinase (CK), and the MB isoenzyme were measured before operation and postoperatively within 2 days.
Results:
Postoperative values of troponin-I for children undergoing extracardiac operation were in the normal range. In children with interventions through the right atrium (n = 10) the mean value increase to 6.5+/-6.1 microg/L (range, 1.8 to 24.3 microg/L) and even to a mean of 29.9+/-21.1 microg/L (range, 7.5 to 90 microg/L) (p<0.01) in children with atrial and additional ventricular surgical approach (n = 23). Troponin-I was of equal specificity and sensitivity compared to troponin-T, excepted in patients with postoperative renal failure in whom troponin-T raised to false pathological results.
Conclusions:
For detection of perioperative myocardial damage troponin-I shows a higher specificity than CK-MB activity and CK-MB mass. The diagnostic value of troponin-I is similar to troponin-T, but compared with troponin-T, it has the advantage of not being influenced by renal failure.