Prognostic Value of Cardiac Troponin and Risk Assessment in Pediatric Supraventricular Tachycardia

Yen, Chieh-Ching; Chen, Shou-Yen; Chaou, Chung-Hsien; Wang, Chih-Kai; Yeh, Hsin-Tzu; Ng, Chip-Jin

doi:10.3390/jcm10163638

Cited by 4 publications

(3 citation statements)

References 29 publications

(39 reference statements)

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“…Research suggests that troponin alone lacks high specificity for diagnosing heart disease. For instance, Yen et al 33 34 found that children with supraventricular tachycardia (SVT) who tested positive for troponin I exhibited clinical symptoms similar to those with normal troponin I levels. Consequently, their findings highlight the limited predictive value of troponin I for SVT recurrence.…”

Section: Discussionmentioning

confidence: 99%

Establishment and validation of a prediction model for myocarditis in Chinese children below 14 years old: a protocol for a retrospective cohort study

Wu,

Ji,

Huang

et al. 2023

BMJ Open

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IntroductionPaediatric myocarditis, a rare inflammatory disease, often presents without clear early symptoms. Although cardiac troponin I levels can aid in diagnosing myocarditis, they are not definitive indicators. Troponin I levels frequently fluctuate within and outside the reference range, potentially causing misinterpretations by clinicians. Although a negative troponin I result is valuable for excluding myocarditis, its specificity is low. Moreover, the clinical diagnosis of paediatric myocarditis is exceptionally challenging, and accurate early-stage diagnosis and treatment pose difficulties. Currently, the Dallas criteria, involving cardiac biopsy, serves as the gold standard for myocarditis diagnosis. However, this method has several drawbacks and is unsuitable for children, resulting in its limited use.Methods and analysisIn this study, we will employ multiple logistic regression analysis to develop a predictive model for early childhood myocarditis. This model will assess the patient’s condition at onset and provide the probability of a myocarditis diagnosis. Model performance will be evaluated for accuracy and calibration, and the results will be presented through receiver operating characteristic (ROC) curves and calibration plots. Clinical decision curve analysis, in conjunction with ROC curve analysis, will be employed to determine the optimal cut-off value and calculate the net clinical benefit value for assessing clinical effectiveness. Finally, internal model validation will be conducted using bootstrapping.Ethics and disseminationApproval from the Clinical Research Ethics Committee of The Third Affiliated Hospital of Wenzhou Medical University has been obtained. The research findings will be disseminated through presentations at scientific conferences and publication in peer-reviewed journals.

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Section: Discussionmentioning

confidence: 99%

Establishment and validation of a prediction model for myocarditis in Chinese children below 14 years old: a protocol for a retrospective cohort study

Wu,

Ji,

Huang

et al. 2023

BMJ Open

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“…Regarding paediatric patients, supraventricular tachycardias represent an important cardiac cause for ED presentation, but in this setting, hs-cTn possesses a low predictive value for the outcomes [ 59 ]. On the other hand, as the incidence of neoplastic pathology is increasing in children, chemotherapy-induced cardiotoxicity became an important health problem.…”

Section: Cardiac Troponins: From Promising To Gold Standardmentioning

confidence: 99%

High-Sensitivity Troponin: A Review on Characteristics, Assessment, and Clinical Implications

Lazar

Homorodean

et al. 2022

Disease Markers

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The use of high-sensitivity cardiac troponin (hs-cTn) assays has become part of the daily practice in most of the laboratories worldwide in the initial evaluation of the typical chest pain. Due to their early surge, the use of hs-cTn may reduce the time needed to recognise myocardial infarctions (MI), which is vital for the patients presenting in the emergency departments for chest pain. The latest European Society of Cardiology Guidelines did not only recognise their central role in the diagnosis algorithm but also recommended their use for rapid rule-in/rule-out of MI. High-sensitivity cardiac troponins are also powerful prognostic markers for long-term events and mortality, not only in a wide spectrum of other cardiovascular diseases (CVD) but also in several non-CVD pathologies. Moreover, these biomarkers became a powerful tool in special populations, such as paediatric patients and, most recently, COVID-19 patients. Although highly investigated, the assessment and interpretation of the hs-cTn changes are still challenging in the patients with basal elevation such as CKD or critically ill patients. Moreover, there are still various analytical characteristics not completely understood, such as circadian or sex variability, with major clinical implications. In this context, the present review focuses on summarizing the most recent research in the current use of hs-cTn, with a main consideration for its role in the diagnosis of MI but also its prognostic value. We have also carefully selected the most important studies regarding the challenges faced by clinicians from different specialties in the correct interpretation of this biomarker. Moreover, future perspectives have been proposed and analysed, as more research and cross-disciplinary collaboration are necessary to improve their performance.

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“…[8] Routine troponin exam in PSVT patients with low risk for coronary artery disease may lead to prolonged length of ED stay, unnecessary exam, and hospitalization. [8][9][10][11][12] However, 1 retrospective study showed elevated troponin I level appear to be associated with adverse outcomes in SVT patients with a history of CAD. [13] This produces doubts as to the prognostic significance of troponin in patients with a huge burden of cardiovascular disease.…”

Section: Introductionmentioning

confidence: 99%

Prognostic value of cardiac troponin in dialysis patients with paroxysmal supraventricular tachycardia

et al. 2022

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A rise in cardiac troponin I (cTnI) is common in supraventricular tachycardia (SVT). While troponin elevation in SVT is thought to be a predictor of future adverse events in patients with prior coronary artery disease, the prognostic significance of cTnI in endstage kidney disease (ESKD) patients with SVT are not known. We aimed to examine the prognostic significance of cTnI in ESKD patients presenting with SVT in the emergency department. This was a retrospective, multiple-center observational study utilizing regularly collected electronic medical records. We screened electronic medical records of all dialysis patients presenting to the emergency departments in 5 hospitals over 12 years with SVT. These patients were divided into whether cTnI was tested, and were further stratified into the cTnI-positive and cTnI-negative groups. The primary outcome of the study was the 3-year risk of major adverse cardiovascular events (MACE). Sixty-two patients were qualified for inclusion. Fifty-seven patients (91.9%) were tested for cTnI, and 5 patients were not. Patients with the cTnI test were older (P = .03) and had a longer length of hospital stay (P < .001). Forty-seven patients (82.5%) had a positive result, and 10 (17.5%) had a negative result. A history of hypertension (P = .013) and decreased left ventricular ejection fraction (P = .048) were the independent predictors of cTnI elevation. After a mean follow-up period of 20.6 ± 14.7 months, there were no differences in 3-year MACE between patients with or without elevated cTnI levels in Kaplan-Meier analysis (P = .34). A history of coronary artery disease was the only independent predictor of 3-year MACE (P = .017). Through the subgroup analysis, a history of coronary artery disease (HR 2.73; CI 1.01-7.41; P = .049) remained an independent risk factor for 3-year MACE in patients with elevated cTnI levels. A large proportion (82.5%) of troponin elevation was observed in ESKD patients with SVT, but it had a poor correlation with MACE.

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Prognostic Value of Cardiac Troponin and Risk Assessment in Pediatric Supraventricular Tachycardia

Cited by 4 publications

References 29 publications

Establishment and validation of a prediction model for myocarditis in Chinese children below 14 years old: a protocol for a retrospective cohort study

Establishment and validation of a prediction model for myocarditis in Chinese children below 14 years old: a protocol for a retrospective cohort study

High-Sensitivity Troponin: A Review on Characteristics, Assessment, and Clinical Implications

Prognostic value of cardiac troponin in dialysis patients with paroxysmal supraventricular tachycardia

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