Study finds elevated cardiac troponin levels in infants with acute SARS-CoV-2 infection

"Long-term consequences are unknown and should be carefully followed," the researchers wrote in The Journal of Pediatrics.

One of the primary targets of SARS-CoV-2 infection is the cardiovascular system. Acute myocardial injury has been documented in adults with acute COVID-19, and individuals experiencing multisystem inflammatory syndrome or vaccine-related complications, because of an immune-mediated mechanism. However, there is a lack of research on the extent of myocardial involvement in children with SARS-CoV-2 infection.

To fill this knowledge gap, Andrea Lo Vecchio (Associate Professor), University of Naples “Federico II” and University Hospital Policlinico “Federico II”, Naples, Italy, and colleagues aimed to investigate the specific role of SARS-CoV-2 in inducing elevation of the marker of myocardial injury in infants with acute COVID-19.

For this purpose, the researchers conducted a prospective, multicentric three-arm comparative study from March 2020 to March 2022. It enrolled 152 infants hospitalized for COVID-19, 79 children with acute infections other than SARS-CoV-2, and 71 healthy controls. The primary outcome was the determination of high-sensitivity troponin (hs-cTn) levels.

The study led to the following findings:

• The proportion of children with hs-cTn values above the upper limit of normal (28.9%), and with a three-fold increased value (13.2%) were significantly higher in the COVID-19 group than those in both control groups.
• There was a higher risk of presenting a three-fold increased hs-cTn value in children with SARS-CoV-2 infection compared with either healthy children (odds ratio [OR] 5.23) or those with other infections (OR 11.89).
• In children with COVID-19, hs-cTn elevation was associated with neither clinical nor biochemical characteristics, nor perinatal risk factors, but with an age below three months (p<0.001).
• After adjustment for age, sex, and underlying clinical conditions, elevated hs-cTn was independently associated with COVID-19 in a multivariable regression model.
• All children showed a progressive reduction of hs-cTn until normalization over time, without clinical, ECG or echocardiographic manifestations up to one year of follow-up.

"Infants with acute SARS-CoV-2 infection may show a transient and subclinical alteration of myocardial injury markers, especially in the first months of life," the researchers wrote.

"hs-cTn levels normalized during follow-up and were not tied to cardiac functional impairment; nevertheless, long-term consequences are unknown and should be followed carefully," they concluded.

Limitations included a younger control group than infected children, participants did not undergo cardiac MRI, and minimal myocardial injury could not be ruled out.

Reference:

Lo Vecchio, A., Scarano, S. M., Pierri, L., Salerno, M., Discepolo, V., Giannattasio, A., Buonsenso, D., Farina, A. M., Catzola, A., Poeta, M., Nunziata, F., Bruzzese, E., & Guarino, A. (2023). High Cardiac Troponin Levels in Infants with Acute SARS-CoV-2 Infection: A Prospective Comparative study. The Journal of Pediatrics, 113876. https://doi.org/10.1016/j.jpeds.2023.113876