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. 2023 Apr;44(4):873-881.
doi: 10.1007/s00246-022-03017-5. Epub 2022 Oct 9.

The Evaluation of Troponin I Levels and Myocarditis in Children with COVID-19: A Pediatric Single-Center Experience

Gizem Guner Ozenen  1 , Aybuke Akaslan Kara  2 , Elif Kiymet  2 , Elif Boncuoglu  2 , Sahika Sahinkaya  2 , Ela Cem  2 , Miray Yilmaz Celebi  2 , Pelin Kacar  2 , Mustafa Gulderen  2 , Meltem Uras  3 , Murat Muhtar Yılmazer  4 , Mehmet Murat  4 , Timur Mese  4 , Hasan Agin  5 , Nuri Bayram  2 , İlker Devrim  2
Affiliations

The Evaluation of Troponin I Levels and Myocarditis in Children with COVID-19: A Pediatric Single-Center Experience

Gizem Guner Ozenen et al. Pediatr Cardiol. 2023 Apr.

Abstract

Children with COVID-19 usually show milder symptoms than adults; however, a minority of them may have cardiac involvement. We aimed to identify the role of troponin I levels that may predict early cardiac involvement in children with COVID-19. A single-center retrospective study was conducted to evaluate hospitalized children diagnosed with COVID-19 between March 11, 2020, and December 31, 2021. Patients with available troponin I levels and with no known cardiac disease were included. During the study period, 412 children with COVID-19 who had troponin I levels on admission were identified. Troponin levels were elevated in 7 (1.7%) patients and were normal in 395 (98.3%) patients. The median age of patients with elevated troponin levels was 4 (min. 2-max. 144) months, which was statistically lower than the age of patients with normal troponin levels (P = 0.035). All the patients with elevated troponin levels had tachycardia. Out of 7 patients with high troponin levels, 3 (42.9%) of them were admitted to the pediatric intensive care unit (PICU), 2 (28.6%) required oxygen support, and 1 (14.3%) required a mechanical ventilator. Patients with elevated troponin levels had a statistically longer hospital stay (P < 0.001). Neutropenia, tachycardia, PICU admission, oxygen support, and mechanical ventilation were statistically more common in patients with elevated troponin levels (P values were 0.033, 0.020, < 0.001, 0.050, and < 0.001, respectively). Electrocardiography (ECG) and echocardiography (ECHO) were performed on all patients with elevated troponin levels, and 6 (85.8%) patients were diagnosed with myocarditis. The ECG and ECHO have been performed in 58 (14.3%) out of 405 patients with normal troponin levels. Two (3.5%) patients had negative T waves on ECG, and all ECHOs were normal. Our results suggest that elevated troponin I levels in children with COVID-19 can be used to evaluate cardiac involvement and decide the need for further pediatric cardiologist evaluation.

Keywords: COVID-19; ECG; ECHO; Pediatrics; Troponin I.

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Conflict of interest statement

The authors have no relevant financial or non-financial interests to disclose.

Figures

Fig. 1
Fig. 1
Scheme of the study design
Fig. 2
Fig. 2
Flow chart of troponin I levels of children hospitalized with COVID-19
Fig. 3
Fig. 3
Troponin I levels of children diagnosed with myocarditis
See this image and copyright information in PMC

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