Key result
Macrotroponin complexes explain falsely elevated troponin in pediatric HCM, ruling out acute cardiac damage.
Why the study?
Elevated troponin T and troponin I can stem from non-cardiac causes, but macrotroponins are easily overlooked, potentially leading to negative consequences.
Case Report (n=1)
Awareness of macrotroponins as a cause of falsely elevated troponin levels can prevent unnecessary, costly diagnostics and prolonged hospital admissions, particularly in pediatric patients.
Macrotroponin interference warrants consideration in unexplained pediatric troponin elevations; single case leaves open prevalence and testing protocols.
Background: Elevated troponin T (cTnT) and/or troponin I (cTnI) can be ascribed to multiple causes, mostly resulting from cardiac tissue damage and in lesser numbers resulting from non-cardiac related causes. The presence of macrotroponins is easily overlooked, with potentially negative consequences. Case summary: This case report presents a case study of a 12-year-old child known to have MYH7 gene-associated hypertrophic cardiomyopathy with acute chest pain combined with an unexpected high cTnT and cTnI. A cardiac cause was deemed unlikely after additional investigation, as these showed no abnormalities. After consulting a laboratory specialist, it could be concluded that the high cTnT and cTnI were a result of macrotroponin complexes, a protein complex consisting of circulating protein and endogenous autoantibodies against that protein, resulting in elevated values with misguiding and uncertain clinical significance. Discussion: Awareness of the existence of macrotroponins could have prevented costly diagnostics and prolonged hospital admission with grave psychological impact, especially in children.
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Avezaath et al. (2023) conducted a case report in Hypertrophic cardiomyopathy with acute chest pain and elevated troponins (n=1). Identification of macrotroponin complexes explained unexpectedly high troponin T and I values in a 12-year-old child with hypertrophic cardiomyopathy, ruling out acute cardiac damage.
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