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Value of Troponin Testing for Detection of Heart Disease in Previously Healthy Children
Background Troponin levels are frequently obtained in pediatric patients, but the benefit remains unclear. Methods and Results This retrospective study included 1993 patients aged 0 to 21 years without history of cardiac disease in whom troponin levels were obtained during clinical evaluation of car...
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| Published in: | Journal of the American Heart Association 2020-02, Vol.9 (4), p.e012897-e012897 |
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| container_title | Journal of the American Heart Association |
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| creator | Dionne, Audrey Kheir, John N Sleeper, Lynn A Esch, Jesse J Breitbart, Roger E |
| description | Background Troponin levels are frequently obtained in pediatric patients, but the benefit remains unclear. Methods and Results This retrospective study included 1993 patients aged 0 to 21 years without history of cardiac disease in whom troponin levels were obtained during clinical evaluation of cardiac and noncardiac presentations. Troponin was elevated (≥0.1 ng/mL) in 182 patients (9%). A cardiac diagnosis was made in 109 (60%) of those with elevated troponin and in 208 (12%) of those without ( |
| doi_str_mv | 10.1161/JAHA.119.012897 |
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<0.001). The positive predictive value of elevated troponin for a cardiac diagnosis was 60% for the entire cohort and 85% for patients with a cardiac presentation. The negative predictive value of nonelevated troponin was 89% for the entire cohort and 96% in patients without a cardiac presentation. Serial testing did not improve these predictive values. However, among 404 patients with initially nonelevated levels who had serial measurements, subsequent elevation was found in 80 (20%), of whom 15 (19%) had a cardiac diagnosis. The optimal troponin cutoff value to differentiate cardiac from noncardiac diagnosis was higher in children aged <3 months (0.045 ng/mL) compared with those aged ≥3 months (0.005 ng/mL). Conclusions Troponin can be a useful adjunctive test in the evaluation of children when the differential diagnosis includes cardiac etiologies. Serial measurement was not helpful when troponin was elevated at presentation but may merit consideration when the initial level is not elevated and there is ongoing concern about cardiac involvement. Lower reference values may be appropriate when evaluating children in contrast to adults.</description><identifier>ISSN: 2047-9980</identifier><identifier>EISSN: 2047-9980</identifier><identifier>DOI: 10.1161/JAHA.119.012897</identifier><identifier>PMID: 32067577</identifier><language>eng</language><publisher>England: John Wiley and Sons Inc</publisher><subject>Adolescent ; Age Factors ; Biomarkers - blood ; Brief Communication ; chest pain ; Child ; Child, Preschool ; children ; Diagnosis, Differential ; Female ; Heart Disease Risk Factors ; Heart Diseases - blood ; Heart Diseases - diagnosis ; Humans ; Infant ; Infant, Newborn ; Male ; Predictive Value of Tests ; reference value ; Reproducibility of Results ; Retrospective Studies ; troponin ; Troponin - blood ; Up-Regulation ; Young Adult</subject><ispartof>Journal of the American Heart Association, 2020-02, Vol.9 (4), p.e012897-e012897</ispartof><rights>2020 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c459t-19811ee2308705b090deb9b8fe02e144e5288947834910504d8ed557aad69cda3</citedby><cites>FETCH-LOGICAL-c459t-19811ee2308705b090deb9b8fe02e144e5288947834910504d8ed557aad69cda3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7070204/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7070204/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,881,27903,27904,53770,53772</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32067577$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Dionne, Audrey</creatorcontrib><creatorcontrib>Kheir, John N</creatorcontrib><creatorcontrib>Sleeper, Lynn A</creatorcontrib><creatorcontrib>Esch, Jesse J</creatorcontrib><creatorcontrib>Breitbart, Roger E</creatorcontrib><title>Value of Troponin Testing for Detection of Heart Disease in Previously Healthy Children</title><title>Journal of the American Heart Association</title><addtitle>J Am Heart Assoc</addtitle><description>Background Troponin levels are frequently obtained in pediatric patients, but the benefit remains unclear. Methods and Results This retrospective study included 1993 patients aged 0 to 21 years without history of cardiac disease in whom troponin levels were obtained during clinical evaluation of cardiac and noncardiac presentations. Troponin was elevated (≥0.1 ng/mL) in 182 patients (9%). A cardiac diagnosis was made in 109 (60%) of those with elevated troponin and in 208 (12%) of those without (
<0.001). The positive predictive value of elevated troponin for a cardiac diagnosis was 60% for the entire cohort and 85% for patients with a cardiac presentation. The negative predictive value of nonelevated troponin was 89% for the entire cohort and 96% in patients without a cardiac presentation. Serial testing did not improve these predictive values. However, among 404 patients with initially nonelevated levels who had serial measurements, subsequent elevation was found in 80 (20%), of whom 15 (19%) had a cardiac diagnosis. The optimal troponin cutoff value to differentiate cardiac from noncardiac diagnosis was higher in children aged <3 months (0.045 ng/mL) compared with those aged ≥3 months (0.005 ng/mL). Conclusions Troponin can be a useful adjunctive test in the evaluation of children when the differential diagnosis includes cardiac etiologies. Serial measurement was not helpful when troponin was elevated at presentation but may merit consideration when the initial level is not elevated and there is ongoing concern about cardiac involvement. Lower reference values may be appropriate when evaluating children in contrast to adults.</description><subject>Adolescent</subject><subject>Age Factors</subject><subject>Biomarkers - blood</subject><subject>Brief Communication</subject><subject>chest pain</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>children</subject><subject>Diagnosis, Differential</subject><subject>Female</subject><subject>Heart Disease Risk Factors</subject><subject>Heart Diseases - blood</subject><subject>Heart Diseases - diagnosis</subject><subject>Humans</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Male</subject><subject>Predictive Value of Tests</subject><subject>reference value</subject><subject>Reproducibility of Results</subject><subject>Retrospective Studies</subject><subject>troponin</subject><subject>Troponin - blood</subject><subject>Up-Regulation</subject><subject>Young Adult</subject><issn>2047-9980</issn><issn>2047-9980</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>DOA</sourceid><recordid>eNpVkc1PGzEQxa2KqiDKubdqj1wC_v64IEUBGiqk9pDC0fJ6ZxMjZx3sDVL--zoNReCLR57n34zeQ-gbwReESHL5czqf1spcYEK1UZ_QCcVcTYzR-OhdfYzOSnnC9UiqmDBf0DGjWCqh1Al6fHBxC03qm0VOmzSEoVlAGcOwbPqUm2sYwY8hDXvFHFwem-tQwBVoqvJ3hpeQtiXu9r04rnbNbBVil2H4ij73LhY4e71P0Z_bm8VsPrn_9eNuNr2feC7MOCFGEwJAGdYKixYb3EFrWt0DpkA4B0G1Nlxpxg3BAvNOQyeEcq6TxneOnaK7A7dL7slucli7vLPJBfvvIeWlrUsHH8F6yQU1xgkvCccEHG1BekakZLKOoJV1dWBttu0aOg_DmF38AP3YGcLKLtOLVVjhancFnL8CcnreVhvtOhQPMboBqk2WMqG4IkyrKr08SH1OpWTo38YQbPfp2n26tTL2kG798f39dm_6_1myv99Fnr8</recordid><startdate>20200218</startdate><enddate>20200218</enddate><creator>Dionne, Audrey</creator><creator>Kheir, John N</creator><creator>Sleeper, Lynn A</creator><creator>Esch, Jesse J</creator><creator>Breitbart, Roger E</creator><general>John Wiley and Sons Inc</general><general>Wiley</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope></search><sort><creationdate>20200218</creationdate><title>Value of Troponin Testing for Detection of Heart Disease in Previously Healthy Children</title><author>Dionne, Audrey ; Kheir, John N ; Sleeper, Lynn A ; Esch, Jesse J ; Breitbart, Roger E</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c459t-19811ee2308705b090deb9b8fe02e144e5288947834910504d8ed557aad69cda3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adolescent</topic><topic>Age Factors</topic><topic>Biomarkers - blood</topic><topic>Brief Communication</topic><topic>chest pain</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>children</topic><topic>Diagnosis, Differential</topic><topic>Female</topic><topic>Heart Disease Risk Factors</topic><topic>Heart Diseases - blood</topic><topic>Heart Diseases - diagnosis</topic><topic>Humans</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Male</topic><topic>Predictive Value of Tests</topic><topic>reference value</topic><topic>Reproducibility of Results</topic><topic>Retrospective Studies</topic><topic>troponin</topic><topic>Troponin - blood</topic><topic>Up-Regulation</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Dionne, Audrey</creatorcontrib><creatorcontrib>Kheir, John N</creatorcontrib><creatorcontrib>Sleeper, Lynn A</creatorcontrib><creatorcontrib>Esch, Jesse J</creatorcontrib><creatorcontrib>Breitbart, Roger E</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>Journal of the American Heart Association</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Dionne, Audrey</au><au>Kheir, John N</au><au>Sleeper, Lynn A</au><au>Esch, Jesse J</au><au>Breitbart, Roger E</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Value of Troponin Testing for Detection of Heart Disease in Previously Healthy Children</atitle><jtitle>Journal of the American Heart Association</jtitle><addtitle>J Am Heart Assoc</addtitle><date>2020-02-18</date><risdate>2020</risdate><volume>9</volume><issue>4</issue><spage>e012897</spage><epage>e012897</epage><pages>e012897-e012897</pages><issn>2047-9980</issn><eissn>2047-9980</eissn><abstract>Background Troponin levels are frequently obtained in pediatric patients, but the benefit remains unclear. Methods and Results This retrospective study included 1993 patients aged 0 to 21 years without history of cardiac disease in whom troponin levels were obtained during clinical evaluation of cardiac and noncardiac presentations. Troponin was elevated (≥0.1 ng/mL) in 182 patients (9%). A cardiac diagnosis was made in 109 (60%) of those with elevated troponin and in 208 (12%) of those without (
<0.001). The positive predictive value of elevated troponin for a cardiac diagnosis was 60% for the entire cohort and 85% for patients with a cardiac presentation. The negative predictive value of nonelevated troponin was 89% for the entire cohort and 96% in patients without a cardiac presentation. Serial testing did not improve these predictive values. However, among 404 patients with initially nonelevated levels who had serial measurements, subsequent elevation was found in 80 (20%), of whom 15 (19%) had a cardiac diagnosis. The optimal troponin cutoff value to differentiate cardiac from noncardiac diagnosis was higher in children aged <3 months (0.045 ng/mL) compared with those aged ≥3 months (0.005 ng/mL). Conclusions Troponin can be a useful adjunctive test in the evaluation of children when the differential diagnosis includes cardiac etiologies. Serial measurement was not helpful when troponin was elevated at presentation but may merit consideration when the initial level is not elevated and there is ongoing concern about cardiac involvement. Lower reference values may be appropriate when evaluating children in contrast to adults.</abstract><cop>England</cop><pub>John Wiley and Sons Inc</pub><pmid>32067577</pmid><doi>10.1161/JAHA.119.012897</doi><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent Age Factors Biomarkers - blood Brief Communication chest pain Child Child, Preschool children Diagnosis, Differential Female Heart Disease Risk Factors Heart Diseases - blood Heart Diseases - diagnosis Humans Infant Infant, Newborn Male Predictive Value of Tests reference value Reproducibility of Results Retrospective Studies troponin Troponin - blood Up-Regulation Young Adult |
| title | Value of Troponin Testing for Detection of Heart Disease in Previously Healthy Children |
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