Question

• In children presenting with signs and/or symptoms consistent with myocarditis, what is the accuracy of cardiac Troponin T levels?

Clinical Bottom Lines

1. Cardiac Troponin T (cTnT) can be used as an adjunct in the diagnosis of myocarditis. The LR (+) for a cutoff of 0.052 ng/ml is 5.07.¹
2. The LR (-) for the same cutoff is 0.34.

Summary of Key Evidence

1. Cohort was comprised of 43 consecutive children admitted with diagnosis of acute heart failure from myocardial dysfunction at Siriraj Hospital in Bangkok, Thailand from July '99 to December '02.
2. Among these children, 24 of 43 patients had myocarditis based on endomyocardial biopsy or resolution of symptoms after 6 months.
3. All patients underwent cTnT testing, with the myocarditis group having a mean of 0.08 ng/ml (0.01-4.93) and the dilated cardiomyopathy group having a mean of 0.01 ng/ml (0.01-0.99).
4. A cTnT level of 0.052 ng/ml gave a sensitivity of 71% and a specificity of 86% for acute myocarditis.

Additional Comments

• This was a limited cohort, performed in a developing nation.
• The authors did not delineate in their paper how they were able to distinguish between the dilated cardiomyopathy group with improvement and the myocarditis group with improvement.

Citation

1. Soongswang J, Durongpisitkul K, Nana A, et al. Cardiac Troponin T: A Marker in the Diagnosis of Acute Myocarditis in Children. Pediatric Cardiology 2005; 26:45-49.
   

CAT Author: Marc Knepp, MD

CAT Appraisers: Alex Kemper, MD

Date appraised: September 21, 2005