title: Predictive value of cardiac troponin T in pediatric patients at risk for myocardial injury.
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.
  
  
  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.
authors.affiliation: Department of Cardiology, Children's Hospital, Boston, Mass, USA. slipshultz@cc.urmc.rochester.edu
authors.forename: S E
authors.initials: SE
authors.lastname: Lipshultz
authors.forename: N
authors.initials: N
authors.lastname: Rifai
authors.forename: S E
authors.initials: SE
authors.lastname: Sallan
authors.forename: S R
authors.initials: SR
authors.lastname: Lipsitz
authors.forename: V
authors.initials: V
authors.lastname: Dalton
authors.forename: D B
authors.initials: DB
authors.lastname: Sacks
authors.forename: M E
authors.initials: ME
authors.lastname: Ottlinger
mesh_terms: D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000032:analysis; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D004317:Doxorubicin / Q000009:adverse effects / Q000627:therapeutic use; D004562:Electrocardiography; D004797:Enzyme-Linked Immunosorbent Assay; D006321:Heart / Q000187:drug effects; D006331:Heart Diseases / Q000097:blood* / Q000139:chemically induced / Q000150:complications / Q000473:pathology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D009206:Myocardium / Q000378:metabolism* / Q000473:pathology; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000188:drug therapy; D011237:Predictive Value of Tests; D014336:Troponin / Q000097:blood*; D020107:Troponin T; D016277:Ventricular Function, Left
chemical_list: D015415:Biomarkers; D014336:Troponin; D020107:Troponin T; D004317:Doxorubicin