Predictive value of cardiac troponin T in pediatric patients at risk for myocardial injury

Steven E. Lipshultz, Nader Rifai, Stephen E. Sallan, Stuart R. Lipsitz, Virginia Dalton, David B. Sacks, Michael E. Ottlinger

Research output: Contribution to journalArticlepeer-review

317 Scopus citations

Abstract

Background: Biochemical markers have not been routinely used in children at risk for myocardial damage. Yet, because of somatic growth and the duration of survival, a low level of myocardial damage may ultimately be of more consequence in children than in adults. Methods and Results: We investigated the utility of cardiac troponin T (cTnT) blood levels (CARDIAC T ELISA Troponin T, Boehringer Mannheim Corp) in 51 consecutively sampled patients from 1 day to 34 years of age (median=5.7 years) undergoing cardiovascular (n=l9) or noncardivascular (n=17) surgery or who received doxorubicin for acute lymphoblastic leukemia (ALL) (n=15). Minimum detectable cTnT elevations were 0.03 ng/mL. cTnT was measurable in children of all ages with myocyte damage. In patients who underwent cardiovascular surgery, a correlation was noted between a score of increasing surgical severity and the mean level of postoperative cTnT (r=.79, P<.0001). Postoperative cTnT levels were elevated in children who completed cardiovascular surgery with an open chest compared with those with a closed chest (P=.0083). In addition, cTnT levels before cardiovascular surgery predicted postoperative survival (P=.007). cTnT elevations were observed after initial doxorubicin therapy for ALL. The magnitude of elevation predicted left ventricular dilatation (r=.80 when variables were treated as continuous. P=.003) and wall thinning (r=.61, P=.044) 9 months later. Conclusions: Elevations of blood cTnT in children relate to the severity of myocardial damage and predict subsequent subclinical and clinical cardiac morbidity and mortality.

Original languageEnglish (US)
Pages (from-to)2641-2648
Number of pages8
JournalCirculation
Volume96
Issue number8
DOIs
StatePublished - Oct 21 1997

Keywords

  • Heart defects, congenital
  • Myocardial infarction
  • Pediatrics doxorubicin
  • Troponin T

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

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