Predicting Cardiac Disease Based on Troponin Levels in Children and Adolescents

Objectives Cardiac troponin (cTn) is frequently used to evaluate pediatric patients with suspected cardiac disease, yet reference thresholds remain poorly established. This study evaluated associations between troponin levels and cardiac pathology identified through diagnostic testing and sought a threshold to identify patients at low risk for cardiac magnetic resonance (CMR)-confirmed myocarditis. Study Design: This single-center retrospective study included patients aged 1–18 years with at least one elevated troponin measurement defined as > 0.029ng/mL at Nationwide Children’s Hospital between January 2014 and December 2024. Medical records were reviewed for cardiac testing, inpatient events, arrhythmias, and outpatient outcomes. Cut point analysis was performed to maximize sensitivity and specificity, with additional analysis targeting a high-sensitivity threshold for CMR-confirmed myocarditis. Results Among 352 patients, troponin demonstrated limited predictive value for abnormalities on echocardiography, electrocardiography, Holter monitoring, and exercise stress testing. Among 149 patients undergoing acute CMR evaluation, a peak troponin threshold of 0.2 ng/mL yielded 95% sensitivity and an 86% negative predictive value for CMR-confirmed myocarditis. Of the patients with a peak troponin below 0.2 ng/mL with an initial normal echocardiogram and electrocardiogram, three patients had recorded inpatient arrhythmia with no sudden cardiac arrests, readmissions, or deaths. Conclusions Troponin elevation demonstrated limited predictive utility across most cardiac diagnostic modalities in children. A peak troponin threshold of 0.2 ng/mL may help guide CMR evaluation and risk stratification. In selected patients, this threshold may inform decisions regarding further evaluation and disposition. Prospective multicenter studies are needed to validate these findings and establish evidence-based clinical recommendations.