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How to interpret cardiac biomarkers in children?
  1. Claire McGinn1,2,
  2. Thomas Waterfield1,
  3. Gareth McKeeman3,
  4. Louise Morrison2,
  5. Sinead Callaghan4,
  6. Chris Watson1,
  7. Frank A Casey1,2
  1. 1 Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
  2. 2 Paediatric Cardiology, Royal Belfast Hospital for Sick Children, Belfast, UK
  3. 3 Belfast Health and Social Care Trust, Belfast, UK
  4. 4 Craigavon Area Hospital, Portadown, UK
  1. Correspondence to Dr Claire McGinn, Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, BT12 6BA, UK; cmcginn09{at}


Cardiac biomarkers are used as first-line diagnostic tools in suspected myocardial injury and heart failure in adult patients. Their use in paediatric patients has been limited by variability caused by age, gender and the presence of an underlying congenital cardiac condition. There are established reference ranges for both NT-proBNP and troponin in healthy children, but these cannot be applied to all paediatric patients because of limited large studies focusing on children with congenital heart disease and/or cardiomyopathy.

This article will focus on the pathophysiology of myocardial injury and heart failure in children and the subsequent cardiac biomarker correlation. It will explain how to interpret the biomarker assay levels obtained for both troponin and NT-proBNP and highlights the importance of a clear clinical question prior to requesting a cardiac biomarker assay level.

Clinical cases outline scenarios that may prompt consideration of biomarker analysis in children and aims to equip the reader with an understanding of how to interpret the results.

  • Paediatrics
  • Child Health
  • Cardiology

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  • Contributors CM codesigned the article, researched the topic, wrote the article and designed tables and figures. TW codesigned the article and critically appraised the drafts. GM wrote sections on technological background to biomarkers and critically appraised the drafts. LM and SC reviewed the article and provided critical appraisal. CW and FAC supervised CM academic work and reviewed the final draft and contributed changes in response to reviewer’s responses.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.