Cardiac troponin I in pediatrics: Normal values and potential use in the assessment of cardiac injury

doi:10.1016/S0022-3476(97)70271-3

The Journal of Pediatrics

Volume 130, Issue 6, June 1997, Pages 872-877

https://doi.org/10.1016/S0022-3476(97)70271-3 Get rights and content

Abstract

Objective: To establish normal values and determine the impact of congenital or acquired heart disease on serum cardiac troponin I (cTnI).

Methods: Concentrations of cTnI were measured in two groups of children. Group A represented ambulatory pediatric patients with no apparent cardiac disease (n = 120) and patients in stable condition with known congenital or acquired cardiac abnormalities (n = 96); group B was composed of patients admitted to intensive care units with normal echocardiograms (n = 16), with abnormal echocardiograms (n = 36), and those with blunt chest trauma who were thought to have cardiac contusions (n = 7).

Results: The cTnI concentrations were generally less than 2.0 ng/ml in group A and frequently below the level of detection for the assay (1.5 ng/ml). There was no statistical difference between the two outpatient subgroups ( p = 0.66). Nine intensive care patients had cTnI values greater than 2.0 ng/ml. Six of these patients, all with abnormal echocardiograms, had values less than 7.7 ng/ml. All improved and had subsequent normal cTnI concentrations. None of the three remaining patients (two with systemic illness [trauma and sepsis] and one with severe pulmonary hypertension), all with values greater than 8.0 ng/ml, survived. Three of the four patients with high likelihood of cardiac contusion had cTnI concentrations greater than 2.0 ng/ml (including one patient who died).

Conclusions: Cardiac troponin-I values are generally not elevated in children with stable cardiac disease or general pediatric conditions. In the context of severe acute illness, significant elevation of cTnI may be an indicator of poor outcome. Elevation of cTnI may also have diagnostic value in cases when cardiac contusion is suspected. (J Pediatr 1997;130:872-7)

Section snippets

Patient population

Initial studies surveyed cTnI concentrations in two broad population groups (designated A and B) in relation to a variety of general pediatric diseases between January 1994 and December 1995.

Group A patients included ambulatory pediatric patients, further subdivided into two groups: group A1 , 120 ambulatory pediatric patients (73 boys/47 girls, mean age 11.6 months, range 0 to 29 months) without apparent heart disease, but with a variety of other pediatric diseases (clinic patients); and group

RESULTS

Serum cTnI values were less than 2.0 ng/ml in 117 of the 120 ambulatory patients without cardiac disease (group A1) and were frequently below the level of detection for the assay, regardless of diagnosis (Table I A).

Table IA. Ambulatory pediatric patients (group A1) (n = 120)

Diagnosis	cTnI ≤2
Gastrointestinal disorders
Diarrhea	14
Vomiting	11
Failure to thrive	6
Constipation	6
Hepatitis	4
Short gut syndrome	3
Gastroesophageal reflux	4
Neurologic disorders
Seizures*	21
Cerebral palsy	5
Developmental delay	3

DISCUSSION

We have shown that cTnI values are usually less than 2.0 ng/ml in the absence of discernible myocardial damage in a wide variety of different pediatric conditions. This finding was consistent in infants and children with hemodynamically stable cyanotic and acyanotic congenital, and nonacute acquired heart disease. It is also evident from our results that moderate elevation of cTnI (<8.0 ng/ml) is rare in a pediatric population, except in critically ill patients. All three critically ill

Acknowledgements

We thank Marsha Kuhns for technical assistance.

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^☆☆: Reprint requests: Michael Landt, PhD, Department of Pediatrics, Washington University School of Medicine, One Children's Place, St. Louis, MO 63110.

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Cardiac troponin I in pediatrics: Normal values and potential use in the assessment of cardiac injury☆,☆☆

Abstract

Section snippets

Patient population

RESULTS

DISCUSSION

Acknowledgements

Ann Thorac Surg

Am Heart J

Chest

J Cardiothorac Vasc Anesth

J Pediatr Surg

Am Heart J

J Am Coll Cardiol

Dev Biol

Development of monoclonal antibodies for an assay of cardiac troponin-I and preliminary results in suspected cases of myocardial infarction

Clin Chem

Cardiac troponin-I: a marker with high specificity for cardiac injury

Circulation