Key result
Children with multisystem inflammatory syndrome (MIS-C) had significantly higher median Pro-BNP levels (2714.5 vs 294 pg/mL) but lower median troponin I levels (145 vs 901 ng/L) compared to those with isolated viral myocarditis.
Why the study?
Both viral etiology and multisystem inflammatory syndrome in children can cause myocardial involvement, but cardiac biomarker profiles had not been compared between the two diseases.
Do cardiac biomarkers (Troponin I, CK-MB, Pro-BNP) differ between children with multisystem inflammatory syndrome (MIS-C) and those with isolated viral myocarditis/myopericarditis?
Observational (n=91)
No
Do cardiac biomarkers (Troponin I, CK-MB, Pro-BNP) differ between children with multisystem inflammatory syndrome (MIS-C) and those with isolated viral myocarditis/myopericarditis?
In pediatric patients, MIS-C is characterized by higher Pro-BNP and worse systemic inflammation, whereas isolated viral myocarditis presents with higher Troponin I and CK-MB levels.
Cardiac biomarker profiles in myocarditis versus MIS-C remain hypothesis-generating; leaves open diagnostic utility pending validation studies.
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.
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Duman et al. (2023) conducted an observational in Acute myocarditis/myopericarditis and Multisystem Inflammatory Syndrome in Children (MIS-C) (n=91). Multisystem inflammatory syndrome in children (MIS-C) vs. Isolated viral myocarditis/myopericarditis was evaluated on Median Pro-BNP level (pg/mL) (p=<0.001). Children with multisystem inflammatory syndrome (MIS-C) had significantly higher median Pro-BNP levels (2714.5 vs 294 pg/mL) but lower median troponin I levels (145 vs 901 ng/L) compared to those with isolated viral myocarditis.
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