Evaluation of child patients applicable with high troponin

Purpose: Cardiac troponins are regulatory proteins located in the thin actin filaments of the myocardium. Troponin is a biomarker that exhibits high specificity and sensitivity in detecting myocardial injury. The aim of our study is to examine the complaints, imaging, and diagnostic processes of children who present to our center with elevated troponin levels. Method: A total of 248 patients, aged 0-18 years, who presented to our hospital with any complaint and had elevated troponin levels between 2012 and 2021 were included in our study. In a retrospective analysis, the patients' demographic characteristics, complaints, imaging findings, medical history, family history, and laboratory data were evaluated. Results: The mean age of the 248 patients included in the study was 95.77±73.63 months. Of these patients, 56.9% were male. The presenting complaints were chest pain in 23.8%, fever and fatigue in 17.7%, dyspnea in 15.7%, and restlessness in 11.3% of patients. The diagnoses were myocarditis in 26.2%, trauma in 9.7%, dilated cardiomyopathy in 9.3%, sepsis in 6.9%, lung disease in 6.9%, and other conditions (such as hyperbilirubinemia, encephalopathy, epilepsy, etc.) in 18.5%, while 0.8% were diagnosed with acute myocardial ischemia (AMI). Troponin levels were highest in patients with AMI, cardiopulmonary arrest, general condition disorder, sepsis, and myocarditis. In patients presenting with acute myocardial infarction, both CK-MB and troponin values were found to be at their highest levels. The highest CK-MB levels were observed in patients presenting with cardiopulmonary arrest. Patients diagnosed with dilated cardiomyopathy had the lowest ejection fraction (EF) values. Of the two patients diagnosed with acute MI who underwent coronary stent treatment, one had Kawasaki disease and the other familial hyperlipidemia. Hospital stay duration and mortality rates were higher in patients diagnosed with sepsis compared to those with other conditions (p<0.001). Conclusion: In our study, it was determined that troponin levels were not significantly elevated in children with nonspecific clinical presentations. The highest troponin levels being observed in conditions such as acute myocardial infarction (AMI), cardiopulmonary arrest, general condition disorder, myocarditis, and sepsis indicates that the clinical situation is significantly more important. Patients with specific cardiac symptoms, comorbid conditions, and family history should definitely have their troponin levels measured. Additionally, we believe that measuring troponin levels is important for assessing prognosis in patients with general deterioration and sepsis. Our study demonstrates that physicians should measure troponin levels in patients after performing a detailed anamnesis and physical examination when encountering such cases. Keywords: Troponin, Child, Myocardium