Frequency of clinically unsuspected myocardial injury at a children's hospital

Steven E Lipshultz, Julia C L Wong, Stuart R. Lipsitz, Valeriano C. Simbre, Karolina M. Zareba, Vartouhi Galpechian, Nader Rifai

Research output: Contribution to journalArticle

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Abstract

Background: Ill children are at risk but rarely screened for myocardial injury. The frequency of such injury in ill children is unknown. Elevated levels of plasma cardiac troponin I (cTnI) can detect subclinical myocardial injury. Methods: We measured cTnI levels from 283 Children's Hospital, Boston patients (median age 2.10 years, range 0.13-22.4 years) seen in an outpatient or emergency clinic without clinically apparent cardiac disease. We took ≥0.5 ng/mL as an indication of myocardial injury. We also measured plasma creatine kinase-MB, total creatine kinase, and myoglobin, and performed a chart review. Results: Fifteen (7.8%) of the 193 acutely ill children and 4 (4.4%) of the 90 well children had an elevated cTnI level (P = .44). Within the acutely ill group, the children with elevated cTnI were younger and had lower mean hemoglobin and hematocrit levels. Cardiac troponin I levels correlated with creatine kinase-MB (r = 0.22; P < .001) but not with creatine kinase or myoglobin. The 4 children with cTnI >0.89 ng/mL, who also had plasma cardiac troponin T measured, showed cardiac troponin T elevations that were consistent with unstable angina levels in adults. Four children had high-level cTnI elevations (>2 ng/mL) consistent with acute myocardial infarction levels in adults. Conclusions: Elevated cTnI levels occur in children without clinically apparent cardiac disease and can be at adult unstable angina or acute myocardial infarction levels. Prospective studies to determine the clinical significance of these findings and their relationship to the development of cardiomyopathy are warranted.

Original languageEnglish
Pages (from-to)916-922
Number of pages7
JournalAmerican Heart Journal
Volume151
Issue number4
DOIs
StatePublished - Apr 1 2006

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Troponin I
Wounds and Injuries
MB Form Creatine Kinase
Troponin T
Unstable Angina
Heart Diseases
Myocardial Infarction
Myoglobin
Creatine Kinase
Cardiomyopathies
Hematocrit
Hemoglobins
Emergencies
Outpatients
Prospective Studies

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Lipshultz, S. E., Wong, J. C. L., Lipsitz, S. R., Simbre, V. C., Zareba, K. M., Galpechian, V., & Rifai, N. (2006). Frequency of clinically unsuspected myocardial injury at a children's hospital. American Heart Journal, 151(4), 916-922. https://doi.org/10.1016/j.ahj.2005.06.029

Frequency of clinically unsuspected myocardial injury at a children's hospital. / Lipshultz, Steven E; Wong, Julia C L; Lipsitz, Stuart R.; Simbre, Valeriano C.; Zareba, Karolina M.; Galpechian, Vartouhi; Rifai, Nader.

In: American Heart Journal, Vol. 151, No. 4, 01.04.2006, p. 916-922.

Research output: Contribution to journalArticle

Lipshultz, SE, Wong, JCL, Lipsitz, SR, Simbre, VC, Zareba, KM, Galpechian, V & Rifai, N 2006, 'Frequency of clinically unsuspected myocardial injury at a children's hospital', American Heart Journal, vol. 151, no. 4, pp. 916-922. https://doi.org/10.1016/j.ahj.2005.06.029
Lipshultz SE, Wong JCL, Lipsitz SR, Simbre VC, Zareba KM, Galpechian V et al. Frequency of clinically unsuspected myocardial injury at a children's hospital. American Heart Journal. 2006 Apr 1;151(4):916-922. https://doi.org/10.1016/j.ahj.2005.06.029
Lipshultz, Steven E ; Wong, Julia C L ; Lipsitz, Stuart R. ; Simbre, Valeriano C. ; Zareba, Karolina M. ; Galpechian, Vartouhi ; Rifai, Nader. / Frequency of clinically unsuspected myocardial injury at a children's hospital. In: American Heart Journal. 2006 ; Vol. 151, No. 4. pp. 916-922.
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AB - Background: Ill children are at risk but rarely screened for myocardial injury. The frequency of such injury in ill children is unknown. Elevated levels of plasma cardiac troponin I (cTnI) can detect subclinical myocardial injury. Methods: We measured cTnI levels from 283 Children's Hospital, Boston patients (median age 2.10 years, range 0.13-22.4 years) seen in an outpatient or emergency clinic without clinically apparent cardiac disease. We took ≥0.5 ng/mL as an indication of myocardial injury. We also measured plasma creatine kinase-MB, total creatine kinase, and myoglobin, and performed a chart review. Results: Fifteen (7.8%) of the 193 acutely ill children and 4 (4.4%) of the 90 well children had an elevated cTnI level (P = .44). Within the acutely ill group, the children with elevated cTnI were younger and had lower mean hemoglobin and hematocrit levels. Cardiac troponin I levels correlated with creatine kinase-MB (r = 0.22; P < .001) but not with creatine kinase or myoglobin. The 4 children with cTnI >0.89 ng/mL, who also had plasma cardiac troponin T measured, showed cardiac troponin T elevations that were consistent with unstable angina levels in adults. Four children had high-level cTnI elevations (>2 ng/mL) consistent with acute myocardial infarction levels in adults. Conclusions: Elevated cTnI levels occur in children without clinically apparent cardiac disease and can be at adult unstable angina or acute myocardial infarction levels. Prospective studies to determine the clinical significance of these findings and their relationship to the development of cardiomyopathy are warranted.

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