Elevation of Cardiac Troponin I in the Acute Stage of Kawasaki Disease

Abstract

The study was performed to investigate the level of serum cardiac troponin I (cTnI), a marker specific for myocardial damage, using a chemiluminescent immunoassay in the acute febrile stage of Kawasaki disease (KD). The study population consisted of 45 KD patients before intravenous gamma-globulin (IVGG) therapy and a control group of 20 patients without KD. Among KD patients the results from measurements of the level of cTnI were positive in 18 cases (40%) and the creatine kinase (CK)-MB was positive in 11 cases (24%), but in the control group both the cTnI and CK-MB results were negative. Seven KD patients (15.6%) showed increases in both cTnI and CK-MB that were significantly correlated with each other (p < 0.05); however, CK-MB is not heart-specific. A significant increase in the level of cTnI in the acute stage of KD suggests that acute myocarditis or myocardial cell injury begins in the early phase of the disease (p < 0.05). The serologic test for cTnI can thus be a useful method for the early diagnosis of acute myocarditis and may enable early treatment with IVGG to reduce the cardiovascular abnormalities in KD patients.

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Statement for Health Professionals From the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association

“…81 Elevation of serum cardiac troponin I, a marker that is specific for myocardial damage, has been reported in acute Kawasaki disease, which is consistent with myocardial cell injury in the early phase of the disease. 82,83 Such elevation was not confirmed in another study. 84 Troponin assays do not play a role in the routine management of children with Kawasaki disease.…”

Cardiac Troponins in Pediatrics

“…The values returned to normal in 16 of 18 after treatment with intravenous immunoglobulin but remained elevated in 2 patients who continued to have clinical myocarditis and heart failure. 54,56 Another author compared 29 patients with KD with 11 controls and found that cTnI did not reliably exceed the predetermined threshold of 0.2 mcg/L in subjects with KD. The authors did not comment on the potential relevance or statistical significance of the fact that the 2 groups of patients with KD had mean cTnI values of 0.11 and 0.15 mg/L compared with controls who had mean values of 0.04 mg/L.…”

“…Cardiac complications occur in up to 20% of affected individuals and include myocarditis, pericardial effusion, congestive heart failure, conduction system abnormalities, and structural damage to the coronary arteries. 54,55 Prompt administration of intravenous immunoglobulin can significantly reduce the incidence of cardiac complications, so timely diagnosis is important. With increasing appreciation of atypical KD, scenarios like the one outlined in the opening of this review confront clinicians regularly.…”

A meta-analysis of the biomarkers associated with coronary artery lesions secondary to Kawasaki disease in Chinese children

“…During the acute phase of KD, a variety of inflammatory factors induce dysfunctions of endothelia of the coronary artery, such as spasm, ischemia of the coronary artery, that contributes to subsequent cardiac-muscle damage [23] . Because of the over-activated inflammatory response and the apparent endothelial damage, damage to the cardiac muscle in the CAL group was more severe than in the NCAL group.…”