Research Article
Cardiac biomarkers comparison between acute myocarditis/myopericarditis and multisystem inflammatory syndrome in children
Abstract
Objectives: Acute myocarditis/myopericarditis is a heterogeneous disorder of unknown origin, the viral etiology leading the first row. There could be also myocardial involvement in multisystem inflammatory syndrome in children (MIS-C). In this study, we aimed to investigate cardiac biomarkers of acute myocarditis/myopericarditis and MIS-C and to compare these parameters between the two diseases.
Methods: Patients who are diagnosed with MIS-C, isolated viral myocarditis/myopericarditis at a university hospital from October 2021 to March 2023 are included in this study.
Results: There were 38 MIS-C patients and 53 patients with myocarditis/myopericarditis. The mean age was 141.2 ± 38.2 months (4 to 18 years old) in MISC, and 145.8 ± 52.1 months (7 to 18 years old) in myocarditis/myopericarditis. Median troponin I level was 145 ng/L in MIS-C patients and it was 901 ng/L in myocarditis/myopericarditis patients. Creatinine kinase-myocardial band (CK-MB) median was 2.25 ng/mL (0.6-6.3) versus 6.7 ng/mL in MIS-C and myocarditis/myopericarditis, respectively. Pro Brain natriuretic peptide (Pro-BNP) median level was 2714.5 pg/mL (<300) in MIS-C, and it was 294 in patients with myocarditis/myopericarditis. Troponin I, CK-MB was significantly higher in myocarditis/myopericarditis, while Pro-BNP was significantly higher in MIS-C patients (p < 0.05). The separating power of CK-MB, troponin I, and Pro-BNP level was significantly higher in the differential diagnosis of these two group patients (p < 0.001). MIS-C patients with high pro-BNP levels had more prolonged hospitalization and left ventricular function impairment according to myocarditis/myopericarditis.
Conclusions: Cardiac biomarkers (CK-MB, troponin I, and Pro-BNP) could be good markers to estimate the course of the diseases.
Keywords
Cardiac biomarkers myocarditis/myopericarditis troponin pro-BNP multisystem inflammatory syndrome
References
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- 22. Ludwikowska KM, Moksud N, Tracewski P, Sokolski M, Szenborn L. Cardiac involvement in patients with multisystem inflammatory syndrome in children (MIS-C) in Poland. Biomedicines 2023;11: 1251.
- 23. Tibi R, Hadash A, Khoury A, Butbul-Aviel Y, Ben-Ari J, Shavit I. Emergency department levels of NT-proBNP and inotropic/vasoactive support in multi-inflammatory syndrome in children (MIS-C). Am J Emerg Med 2022;56:296-7.
- 24. Landesberg G, Jaffe AS, Gilon D, Levin PD, Goodman S, Abu-Baih A, et al. Troponin elevation in severe sepsis and septic shock: the role of left ventricular diastolic dysfunction and right ventricular dilatation. Crit Care Med 2014;42:790-800.
- 25. Ganguly M, Nandi A, Banerjee P, Gupta P, Sarkar SD, Basu S, et al. A comparative study of IL‐6, CRP and NT‐proBNP levels in post‐COVID multisystem inflammatory syndrome in children (MISC) and Kawasaki disease patients. Int J Rheum Dis 2022;25:27-31.
Year 2023,
Volume: 9 Issue: 5 - September 2023, 1251 - 1257, 04.09.2023
Abstract
References
- 1. Adler Y, Charron P, Imazio M, Badano L, Barón-Esquivias G, Bogaert J, et al. 2015 ESC Guidelines for the diagnosis and management of pericardial diseases: The Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC)Endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2015;36:2921-64.
- 2. Law YM, Lal AK, Chen S, Čiháková D, Cooper Jr LT, Deshpande S, et al. Diagnosis and management of myocarditis in children: a scientific statement from the American Heart Association. Circulation 2021;144:e123-35.
- 3. Sperotto F, Friedman KG, Son MBF, VanderPluym CJ, Newburger JW, Dionne A. Cardiac manifestations in SARS-CoV-2-associated multisystem inflammatory syndrome in children: a comprehensive review and proposed clinical approach. Eur J Pediatr 2021;180:307-22.
- 4. Riphagen S, Gomez X, Gonzalez-Martinez C, Wilkinson N, Theocharis P. Hyperinflammatory shock in children during COVID-19 pandemic. Lancet 2020;395:1607-8.
- 5. Son MBF, Burns JC, Newburger JW. A new definition for multisystem inflammatory syndrome in children. Pediatrics 2023;151:e2022060302
- 6. Melgar M, Lee EH, Miller AD, Lim S, Brown CM, Yousaf AR, et al. Council of state and territorial epidemiologists/CDC surveillance case definition for multisystem inflammatory syndrome in children associated with SARS-CoV-2 infection - United States. MMWR Recomm Rep 2022;71:1-14.
- 7. Shah HP, Frye R, Chang S, Faherty E, Steele J, Karnik R. Challenges of diagnosing viral myocarditis in adolescents in the era of COVID-19 and MIS-C. Case Rep Pediatr 2021;2021:4797498.
- 8. Patel T, Kelleman M, West Z, Peter A, Dove M, Butto A, et al. Comparison of multisystem inflammatory syndrome in children–related myocarditis, classic viral myocarditis, and covid‐19 vaccine‐related myocarditis in children. J Am Heart Assoc 2022;11:e024393.
- 9. Putschoegl A, Auerbach S. Diagnosis, evaluation, and treatment of myocarditis in children. Pediatr Clin North Am 2020;67:855-74.
- 10. Aimo A, Januzzi JL, Jr., Mueller C, Mirò O, Pascual Figal DA, Jacob J, et al. Admission high-sensitivity troponin T and NT-proBNP for outcome prediction in acute heart failure. Int J Cardiol 2019;293:137-42.
- 11. Wettersten N. Biomarkers in acute heart failure: diagnosis, prognosis, and treatment. Int J Heart Fail 2021;3:81-105.
- 12. Lam E, Higgins V, Zhang L, Chan MK, Bohn MK, Trajcevski K, et al. Normative values of high-sensitivity cardiac troponin T and N-terminal pro-B-type natriuretic peptide in children and adolescents: a study from the CALIPER cohort. J Appl Lab Med 2020;6:344-53.
- 13. Suresh A, Martens P, Tang WHW. Biomarkers for myocarditis and inflammatory cardiomyopathy. Curr Heart Fail Rep 2022;19:346-55.
- 14. Centers for Disease Control and Prevention. Partner updates: case definition for MISC-C. Accessed December 4 hwcgm-ch. Centers for Disease Control and Prevention. Partner updates: case definition for MISC-C. Accessed December 4, 2020. https://www.cdc.gov/ mis-c/hcp/: Centers for Disease Control and Prevention. Partner updates: case definition for MISC-C. Accessed December 4, 2020. https://www.cdc.gov/ mis-c/hcp/; 2020
- 15. Butts RJ, Boyle GJ, Deshpande SR, Gambetta K, Knecht KR, Prada-Ruiz CA, et al. Characteristics of clinically diagnosed pediatric myocarditis in a contemporary multi-center cohort. Pediatr Cardiol 2017;38:1175-82.
- 16. Caforio AL, Pankuweit S, Arbustini E, Basso C, Gimeno-Blanes J, Felix SB, et al. Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J 2013;34:2636-48.a-d.
- 17. Vukomanovic VA, Krasic S, Prijic S, Ninic S, Minic P, Petrovic G, et al. Differences between pediatric acute myocarditis related and unrelated to SARS-CoV-2. Pediatr Infect Dis J 2021;40:e173-8.
- 18. Alsaied T, Tremoulet AH, Burns JC, Saidi A, Dionne A, Lang SM, et al. Review of cardiac involvement in multisystem inflammatory syndrome in children. Circulation 2021;143:78-88.
- 19. Aboughdir M, Kirwin T, Abdul Khader A, Wang B. Prognostic value of cardiovascular biomarkers in COVID-19: a review. Viruses 2020;12:527.
- 20. Smith SC, Ladenson JH, Mason JW, Jaffe AS. Elevations of cardiac troponin I associated with myocarditis: experimental and clinical correlates. Circulation 1997;95:163-8.
- 21. Imazio M, Brucato A, Barbieri A, Ferroni F, Maestroni S, Ligabue G, et al. Good prognosis for pericarditis with and without myocardial involvement: results from a multicenter, prospective cohort study. Circulation 2013;128:42-9.
- 22. Ludwikowska KM, Moksud N, Tracewski P, Sokolski M, Szenborn L. Cardiac involvement in patients with multisystem inflammatory syndrome in children (MIS-C) in Poland. Biomedicines 2023;11: 1251.
- 23. Tibi R, Hadash A, Khoury A, Butbul-Aviel Y, Ben-Ari J, Shavit I. Emergency department levels of NT-proBNP and inotropic/vasoactive support in multi-inflammatory syndrome in children (MIS-C). Am J Emerg Med 2022;56:296-7.
- 24. Landesberg G, Jaffe AS, Gilon D, Levin PD, Goodman S, Abu-Baih A, et al. Troponin elevation in severe sepsis and septic shock: the role of left ventricular diastolic dysfunction and right ventricular dilatation. Crit Care Med 2014;42:790-800.
- 25. Ganguly M, Nandi A, Banerjee P, Gupta P, Sarkar SD, Basu S, et al. A comparative study of IL‐6, CRP and NT‐proBNP levels in post‐COVID multisystem inflammatory syndrome in children (MISC) and Kawasaki disease patients. Int J Rheum Dis 2022;25:27-31.
There are 25 citations in total.
Details
| Primary Language | English |
|---|---|
| Subjects | Pediatric Cardiology |
| Journal Section | Original Articles |
| Authors | |
| Early Pub Date | August 31, 2023 |
| Publication Date | September 4, 2023 |
| Submission Date | August 21, 2023 |
| Acceptance Date | August 31, 2023 |
| Published in Issue | Year 2023 Volume: 9 Issue: 5 - September 2023 |
e-ISSN: 2149-3189
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