(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
This article has been cited by other articles:
 |
|
 |
|
  L. Gianni, E. H. Herman, S. E. Lipshultz, G. Minotti, N. Sarvazyan, and D. B. Sawyer Anthracycline Cardiotoxicity: From Bench to Bedside J. Clin. Oncol., August 1, 2008; 26(22): 3777 - 3784. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. M Maddali, J. Valliattu, T. al Delamie, S. Zacharias, A. R Ahmed, and S. S Ganguly Arterial Switch Operation: Troponin T Does Not Predict Ventilation Requirements Asian Cardiovasc Thorac Ann, August 1, 2008; 16(4): 274 - 277. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. E Lipshultz, J. A Alvarez, and R. E Scully Anthracycline associated cardiotoxicity in survivors of childhood cancer Heart, April 1, 2008; 94(4): 525 - 533. [Full Text] [PDF]
|
|
|
|
 |
|
 S. M. Shankar, N. Marina, M. M. Hudson, D. C. Hodgson, M. J. Adams, W. Landier, S. Bhatia, K. Meeske, M. H. Chen, K. E. Kinahan, et al. Monitoring for Cardiovascular Disease in Survivors of Childhood Cancer: Report From the Cardiovascular Disease Task Force of the Children's Oncology Group Pediatrics, February 1, 2008; 121(2): e387 - e396. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. E. Scully, T. L. Miller, and S. E. Lipshultz Detecting Anthracycline-induced Cardiotoxicity in Survivors of Childhood Cancer ASCO Educational Book, January 1, 2008; 2008(1): 454 - 458. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 NACB WRITING GROUP MEMBERS, A. H.B. Wu, A. S. Jaffe, F. S. Apple, R. L. Jesse, G. L. Francis, D. A. Morrow, L. K. Newby, J. Ravkilde, W.H. W. Tang, et al. National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines: Use of Cardiac Troponin and B-Type Natriuretic Peptide or N-Terminal proB-Type Natriuretic Peptide for Etiologies Other than Acute Coronary Syndromes and Heart Failure Clin. Chem., December 1, 2007; 53(12): 2086 - 2096. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. H. Mildh, V. Pettila, H. I. Sairanen, and P. H. Rautiainen Cardiac Troponin T Levels for Risk Stratification in Pediatric Open Heart Surgery Ann. Thorac. Surg., November 1, 2006; 82(5): 1643 - 1648. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Cardinale, G. Lamantia, and C. M. Cipolla Troponin I and Cardiovascular Risk Stratification in Patients With Testicular Cancer J. Clin. Oncol., July 20, 2006; 24(21): 3508 - 3508. [Full Text] [PDF]
|
|
|
|
 |
|
 M. Marty, M. Espie, A. Llombart, A. Monnier, B. L. Rapoport, V. Stahalova, and On behalf of the Dexrazoxane Study Group Multicenter randomized phase III study of the cardioprotective effect of dexrazoxane (Cardioxane(R)) in advanced/metastatic breast cancer patients treated with anthracycline-based chemotherapy Ann. Onc., April 1, 2006; 17(4): 614 - 622. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. D. Floyd, D. T. Nguyen, R. L. Lobins, Q. Bashir, D. C. Doll, and M. C. Perry Cardiotoxicity of Cancer Therapy J. Clin. Oncol., October 20, 2005; 23(30): 7685 - 7696. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Kilickap, I. Barista, E. Akgul, K. Aytemir, S. Aksoyek, S. Aksoy, I. Celik, S. Kes, and G. Tekuzman cTnT can be a useful marker for early detection of anthracycline cardiotoxicity Ann. Onc., May 1, 2005; 16(5): 798 - 804. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. E. Lipshultz, S. R. Lipsitz, S. E. Sallan, V. M. Dalton, S. M. Mone, R. D. Gelber, and S. D. Colan Chronic Progressive Cardiac Dysfunction Years After Doxorubicin Therapy for Childhood Acute Lymphoblastic Leukemia J. Clin. Oncol., April 20, 2005; 23(12): 2629 - 2636. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. E. Lipshultz, N. Rifai, V. M. Dalton, D. E. Levy, L. B. Silverman, S. R. Lipsitz, S. D. Colan, B. L. Asselin, R. D. Barr, L. A. Clavell, et al. The Effect of Dexrazoxane on Myocardial Injury in Doxorubicin-Treated Children with Acute Lymphoblastic Leukemia N. Engl. J. Med., July 8, 2004; 351(2): 145 - 153. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. T.H. Yeh, A. T. Tong, D. J. Lenihan, S. W. Yusuf, J. Swafford, C. Champion, J.-B. Durand, H. Gibbs, A. A. Zafarmand, and M. S. Ewer Cardiovascular Complications of Cancer Therapy: Diagnosis, Pathogenesis, and Management Circulation, June 29, 2004; 109(25): 3122 - 3131. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Cardinale, M. T. Sandri, A. Colombo, N. Colombo, M. Boeri, G. Lamantia, M. Civelli, F. Peccatori, G. Martinelli, C. Fiorentini, et al. Prognostic Value of Troponin I in Cardiac Risk Stratification of Cancer Patients Undergoing High-Dose Chemotherapy Circulation, June 8, 2004; 109(22): 2749 - 2754. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Hasegawa, N. Yoshimura, S. Oka, Y. Ootaki, Y. Toyoda, and M. Yamaguchi Evaluation of heart fatty acid-binding protein as a rapid indicator for assessment of myocardial damage in pediatric cardiac surgery J. Thorac. Cardiovasc. Surg., June 1, 2004; 127(6): 1697 - 1702. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I. Oztop, M. Gencer, T. Okan, A. Yaren, E. Altekin, S. Turker, and U. Yilmaz Evaluation of Cardiotoxicity of a Combined Bolus plus Infusional 5-Fluorouracil/Folinic Acid Treatment by Echocardiography, Plasma Troponin I Level, QT Interval and Dispersion in Patients with Gastrointestinal System Cancers Jpn. J. Clin. Oncol., May 1, 2004; 34(5): 262 - 268. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W B Borke, B H Munkeby, L Morkrid, E Thaulow, and O D Saugstad Resuscitation with 100% O2 does not protect the myocardium in hypoxic newborn piglets Arch. Dis. Child. Fetal Neonatal Ed., March 1, 2004; 89(2): F156 - F160. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Z. L. Nagy, M. Collins, T. Sharpe, S. Mirsadraee, R. R. Guerrero, J. Gibbs, and K. G. Watterson Effect of Two Different Bypass Techniques on the Serum Troponin-T Levels in Newborns and Children: Does pH-Stat Provide Better Protection? Circulation, August 5, 2003; 108(5): 577 - 582. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Kamblock, L. Payot, B. Iung, P. Costes, T. Gillet, C. Le Goanvic, P. Lionet, B. Pagis, J. Pasche, C. Roy, et al. Does rheumatic myocarditis really exists? Systematic study with echocardiography and cardiac troponin I blood levels Eur. Heart J., May 1, 2003; 24(9): 855 - 862. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. T. Sandri, D. Cardinale, L. Zorzino, R. Passerini, P. Lentati, A. Martinoni, G. Martinelli, and C. M. Cipolla Minor Increases in Plasma Troponin I Predict Decreased Left Ventricular Ejection Fraction after High-Dose Chemotherapy Clin. Chem., February 1, 2003; 49(2): 248 - 252. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. H. Hovels-Gurich, J. F. Vazquez-Jimenez, A. Silvestri, K. Schumacher, R. Minkenberg, J. Duchateau, B. J. Messmer, G. von Bernuth, and M.-C. Seghaye Production of proinflammatory cytokines and myocardial dysfunction after arterial switch operation in neonates with transposition of the great arteries J. Thorac. Cardiovasc. Surg., October 1, 2002; 124(4): 811 - 820. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M.I. Gharib and A.K. Burnett Chemotherapy-induced cardiotoxicity: current practice and prospects of prophylaxis Eur J Heart Fail, June 1, 2002; 4(3): 235 - 242. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Cardinale, M. T. Sandri, A. Martinoni, E. Borghini, M. Civelli, G. Lamantia, S. Cinieri, G. Martinelli, C. Fiorentini, and C. M. Cipolla Myocardial injury revealed by plasma troponin I in breast cancer treated with high-dose chemotherapy Ann. Onc., May 1, 2002; 13(5): 710 - 715. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. E. Lipshultz, A. L. Giantris, S. R. Lipsitz, V. K. Dalton, B. L. Asselin, R. D. Barr, L. A. Clavell, C. A. Hurwitz, A. Moghrabi, Y. Samson, et al. Doxorubicin Administration by Continuous Infusion Is Not Cardioprotective: The Dana-Farber 91-01 Acute Lymphoblastic Leukemia Protocol J. Clin. Oncol., March 15, 2002; 20(6): 1677 - 1682. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. W. Auner, C. Tinchon, W. Linkesch, G. Halwachs-Baumann, and H. Sill Correspondence re: O. J. Arola et al., Acute Doxorubicin Cardiotoxicity Involves Cardiomyocyte Apoptosis. Cancer Res., 60: 1789-1792, 2000. Cancer Res., March 1, 2001; 61(5): 2335 - 2336. [Full Text]
|
|
|
|
 |
|
 N. Parekh, B. Venkatesh, D. Cross, A. Leditschke, J. Atherton, W. Miles, A. Winning, A. Clague, and C. Rickard Cardiac troponin I predicts myocardial dysfunction in aneurysmal subarachnoid hemorrhage J. Am. Coll. Cardiol., October 1, 2000; 36(4): 1328 - 1335. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Cardinale, M. T. Sandri, A. Martinoni, A. Tricca LabTech, M. Civelli, G. Lamantia, S. Cinieri, G. Martinelli, C. M. Cipolla, and C. Fiorentini Left ventricular dysfunction predicted by early troponin I release after high-dose chemotherapy J. Am. Coll. Cardiol., August 1, 2000; 36(2): 517 - 522. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. A. Labarrere, D. R. Nelson, C. J. Cox, D. Pitts, P. Kirlin, and H. Halbrook Cardiac-Specific Troponin I Levels and Risk of Coronary Artery Disease and Graft Failure Following Heart Transplantation JAMA, July 26, 2000; 284(4): 457 - 464. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. Feleszko, I. Mlynarczuk, E. Z. Balkowiec-Iskra, A. Czajka, T. Switaj, T. Stoklosa, A. Giermasz, and M. Jakobisiak Lovastatin Potentiates Antitumor Activity and Attenuates Cardiotoxicity of Doxorubicin in Three Tumor Models in Mice Clin. Cancer Res., May 1, 2000; 6(5): 2044 - 2052. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Fredericks, P. O. Collinson, D. W. Holt, P. A. Isotalo, D. C. Greenway, and J. G. Donnelly Response to ""Increased Creatine Kinase MB and Cardiac Troponin T with Normal Cardiac Troponin I in Metastatic Alveolar Rhabdomyosarcoma"" • The authors of the Letter cited above reply: Clin. Chem., March 1, 2000; 46(3): 432 - 435. [Full Text] [PDF]
|
|
|
|
 |
|
 D. B Sacks Acute coronary ischemia: troponin I and T Vascular Medicine, November 1, 1999; 4(4): 253 - 256. [Abstract] [PDF]
|
|
|
|
|
|
R. R. Chaturvedi, D. F. Shore, C. Lincoln, S. Mumby, M. Kemp, J. Brierly, A. Petros, J. M.G. Gutteridge, J. Hooper, and A. N. Redington Acute Right Ventricular Restrictive Physiology After Repair of Tetralogy of Fallot : Association With Myocardial Injury and Oxidative Stress Circulation, October 5, 1999; 100(14): 1540 - 1547. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. H. Herman, J. Zhang, S. E. Lipshultz, N. Rifai, D. Chadwick, K. Takeda, Z.-X. Yu, and V. J. Ferrans Correlation Between Serum Levels of Cardiac Troponin-T and the Severity of the Chronic Cardiomyopathy Induced by Doxorubicin J. Clin. Oncol., July 1, 1999; 17(7): 2237 - 2237. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L.C.M. Kremer, M.M.C. Tiel-van Buul, M.C. Ubbink, M. Offringa, J. Ottenkamp, R. V. Olmos, and P.A. Voute Indium-111-Antimyosin Scintigraphy in the Early Detection of Heart Damage After Anthracycline Therapy in Children J. Clin. Oncol., April 1, 1999; 17(4): 1208 - 1208. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. E. Lipshultz, M. A. Grenier, S. D. Colan, A. D. Ginsburg, S. M. Swain, F. M. Muggia, J. L. Speyer, P. K. Singal, C. L.M. Olweny, and T. Li Doxorubicin-Induced Cardiomyopathy N. Engl. J. Med., February 25, 1999; 340(8): 653 - 655. [Full Text]
|
|
|
|
|
|
K. Makikallio, O. Vuolteenaho, P. Jouppila, and J. Rasanen Ultrasonographic and Biochemical Markers of Human Fetal Cardiac Dysfunction in Placental Insufficiency Circulation, April 30, 2002; 105(17): 2058 - 2063. [Abstract] [Full Text] [PDF]
|
|