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(Circulation. 1997;96:2641-2648.)
© 1997 American Heart Association, Inc.
Articles |
Predictive Value of Cardiac Troponin T in Pediatric Patients at Risk for Myocardial Injury
From the Department of Cardiology (S.E.L.), Department of Laboratory Medicine (N.R.), and Division of Hematology-Oncology (S.E.S.), Children's Hospital, Boston, Mass; the Division of Biostatistics (S.R.L.), and Department of Pediatric Oncology (S.E.S., V.D.), Dana Farber Cancer Institute, Boston; the Department of Pathology (D.B.S.), Brigham and Woman's Hospital, Boston, Mass; the Department of Biostatistics (S.R.L.), Harvard School of Public Health, Boston, Mass; the Department of Pediatrics (S.E.L., S.E.S.), and Department of Pathology (N.R., D.B.S.), Harvard Medical School, Boston, Mass; the Department of Pathology (M.E.O.), Boston Veteran's Administration Medical Center (Mass); and the Department of Pathology (M.E.O.), Boston University School of Medicine, Boston, Mass.
Correspondence to Steven E. Lipshultz, MD, Division of Pediatric Cardiology, University of Rochester Medical Center, 601 Elmwood Ave, Box 631, Rochester, NY 14642. E-mail slipshultz{at}cc.urmc.rochester.edu
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=19) or noncardiovascular (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.
Key Words: myocardial infarction • pediatrics • doxorubicin • heart defects, congenital • troponin T
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