{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T02:53:54Z","timestamp":1789872834178,"version":"4.0.1"},"reference-count":21,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2025,7,22]],"date-time":"2025-07-22T00:00:00Z","timestamp":1753142400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Elevated troponin levels are widely recognized as key biomarkers of myocardial injury and are frequently used in clinical decision making. However, not all instances of troponin elevation indicate true cardiac damage. In some cases, biochemical or immunological interferences may lead to false-positive results. These situations may lead to unnecessary diagnostic interventions and clinical uncertainty, ultimately impacting patient management negatively. This study aims to investigate the underlying mechanisms of false-positive troponin elevation in pediatric patients, focusing on factors such as macrotroponin formation, autoantibodies, and heterophile antibody interference. Methods: This retrospective study analyzed data from 13 pediatric patients who presented with elevated cardiac troponin levels between 2017 and 2024. Clinical evaluations included transthoracic echocardiography (TTE), electrocardiography (ECG), coronary computed tomography angiography (CTA), cardiac magnetic resonance imaging (MRI), and rheumatologic testing. Laboratory findings included measurements of cardiac troponins (cTnI and hs-cTnT) and pro-BNP levels. Results: Among 70 patients evaluated for elevated troponin levels, 13 (18.6%) were determined to have no identifiable cardiac etiology. The median age of these 13 patients was 13.0 years (range: 9\u201316), with 53.8% being female. The most common presenting complaints were chest pain (53.8%) and palpitations (30.8%). TTE findings were normal in 61.5% of the patients, and all patients had normal coronary CTA and cardiac MRI findings. Although initial troponin I levels were elevated in all cases, persistent positivity was observed up to 12 months. Median cTnI levels were 1.00 ng\/mL (range: 0.33\u20137.19) at week 1 and 0.731 ng\/mL (range: 0.175\u20134.56) at month 12. PEG precipitation testing identified macrotroponin in three patients (23.1%). No etiological explanation could be identified in 10 cases (76.9%), which were considered idiopathic. All patients had negative results for heterophile antibody and rheumatologic tests. Conclusions: When interpreting elevated troponin levels in children, biochemical interferences\u2014especially macrotroponin\u2014should not be overlooked. This study emphasizes the diagnostic uncertainty associated with non-cardiac troponin elevation. To better guide clinical practice and clarify false positivity rates, larger, multicenter prospective studies are needed.<\/jats:p>","DOI":"10.3390\/diagnostics15151847","type":"journal-article","created":{"date-parts":[[2025,7,22]],"date-time":"2025-07-22T15:00:42Z","timestamp":1753196442000},"page":"1847","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["False Troponin Elevation in Pediatric Patients: A Long-Term Biochemical Conundrum Without Cardiac Effects"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6349-2514","authenticated-orcid":false,"given":"Ceren","family":"Yapar G\u00fcm\u00fc\u015f","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Ordu University Faculty of Medicine, 52200 Alt\u0131nordu, Ordu, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6741-3323","authenticated-orcid":false,"given":"Taner","family":"Kasar","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology, Department of Pediatrics, Ordu University Faculty of Medicine, 52200 Alt\u0131nordu, Ordu, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meltem","family":"Boz","sequence":"additional","affiliation":[{"name":"Department of Biochemistry, Ordu Training and Research Hospital, 52200 Alt\u0131nordu, Ordu, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1762-3269","authenticated-orcid":false,"given":"Erkut","family":"Ozturk","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology, Basaksehir Cam ve Sakura City Hospital, 34480 Basaksehir, Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"860","DOI":"10.1016\/j.pathol.2021.04.005","article-title":"Effect of macrotroponin on the utility of cardiac troponin I as a prognostic biomarker for long term total and cardiovascular disease mortality","volume":"53","author":"Lam","year":"2021","journal-title":"Pathology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e2022058374","DOI":"10.1542\/peds.2022-058374","article-title":"Persistent elevation of troponin I in a pediatric patient resulting from macrotroponin complex","volume":"151","author":"Harberg","year":"2023","journal-title":"Pediatrics"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Fogliazza, F., Cifaldi, M., Antoniol, G., Canducci, N., and Esposito, S. 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