Characterization of Cardiac Troponin Elevation in the Setting of Pediatric Supraventricular Tachycardia.
Cardiac troponin (cTn) is currently considered the gold standard biomarker for detection of myocardial necrosis. Patients with supraventricular tachycardia (SVT) often present with symptoms resulting in cTn assessment; however, there are no data on the results of such testing in childhood. We hypothesized that cTn elevation would be common in the pediatric SVT population and would portend a benign prognosis. A retrospective review of all pediatric patients (≤21 years) presenting with SVT was performed. Clinical and electrocardiographic variables from the emergency department (ED) presentation were reviewed and clinical outcomes during subsequent follow-up assessed. Of 128 patients seen in the ED for SVT, cTn was assessed in 48 (38 %). Of patients with cTn assessment, 14 (29 %) patients demonstrated cTn elevation. Univariate predictors of cTn elevation included presentation with respiratory or gastrointestinal symptoms (50 vs 12 % and 42 vs 9 %; p = 0.008 and p = 0.01, respectively), lower mean arterial blood pressure (73 vs 85 mm Hg, p = 0.009), higher age-adjusted tachycardia rate (z score 9.3 vs 7.2, p < 0.001), and longer tachycardia duration (4.2 vs 1.0 h, p = 0.02). Multivariate logistic regression confirmed the association of age-adjusted tachycardia rate (odds ratio [OR] 3.8 per heart rate z score, confidence interval [CI] 1.9-11.8, p = 0.003) and duration (OR 1.5 per hour, CI 1.1-2.5, p = 0.03). Clinical outcome was excellent with no adverse sequelae during a median of 2.9 years of follow-up. Cardiac Tn elevation is common in the pediatric population presenting with SVT. Episode severity, characterized by respiratory or gastrointestinal symptoms, lower mean blood pressure, and increased tachycardia rate and duration are predictive. Clinical follow-up is favorable.
Division of Cardiology, Department of Pediatrics, UCLA Medical Center, 200 Medical Plaza Dr. Suite 330, Los Angeles, CA, 90095, USA. jpmoore@mednet.ucla.edu.
Jeremy P
JP
Moore
Division of Cardiology, Department of Pediatrics, UCLA Medical Center, 200 Medical Plaza Dr. Suite 330, Los Angeles, CA, 90095, USA.
Lisa
L
Arcilla
Division of Cardiology, Department of Pediatrics, UCLA Medical Center, 200 Medical Plaza Dr. Suite 330, Los Angeles, CA, 90095, USA.
Shuo
S
Wang
Division of Cardiology, Department of Medicine, UCLA Medical Center, 100 Medical Plaza Dr. Suite 630, Los Angeles, CA, 90095, USA.
Michael S
MS
Lee
Division of Cardiology, Department of Pediatrics, UCLA Medical Center, 200 Medical Plaza Dr. Suite 330, Los Angeles, CA, 90095, USA.
Kevin M
KM
Shannon
D000293:Adolescent; D015415:Biomarkers / Q000097:blood; D002140:California; D002648:Child; D016208:Databases, Factual; D004562:Electrocardiography; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011379:Prognosis; D012189:Retrospective Studies; D013617:Tachycardia, Supraventricular / Q000097:blood* / Q000175:diagnosis*; D013997:Time Factors; D019210:Troponin I / Q000097:blood*
D015415:Biomarkers; D019210:Troponin I
Cardiac troponin; Electrocardiogram; Pediatrics; Supraventricular tachycardia