Troponin at presentation: A key predictor of chronic myocardial impairment post-myocarditis—A prospective cohort study

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Objectives Myocarditis may lead to persistent myocardial impairment. We evaluated whether admission troponin I and inflammatory biomarkers predict one-year myocardial impairment using global longitudinal strain (GLS) as the reference outcome. Design Prospective, single-center cohort study (2013–2023); approved by the Kaplan Medical Center Institutional Review Board (KMC-10-0068). Setting Kaplan Medical Center, Israel. Participants A total of 115 patients were admitted with myocarditis, defined by ESC criteria. Main outcome measures Admission biomarkers included troponin I (pg/mL), white blood cells (WBC; × 10 9 /L), C-reactive protein (CRP; mg/L), and erythrocyte sedimentation rate (ESR; mm/h). One-year myocardial function was assessed by speckle-tracking echocardiography. Impairment was defined as GLS > –19.5%. Predictive performance was evaluated with Firth logistic regression and ROC analysis. Results Myocardial impairment occurred in 22.6% (26/115). Median troponin I was higher in impaired versus non-impaired patients (11,517 vs 5918 pg/mL; p < 0.001). WBC was elevated (12.79 vs 9.90 × 10 9 /L; p < 0.001), with higher CRP (11.44 vs 9.05 mg/L; p = 0.031) and ESR (36 vs 21 mm/h; p = 0.04). In multivariable models, troponin I (coefficient 0.000526; p < 0.001), WBC (0.273; p = 0.001), CRP (0.065; p = 0.031), and LV E/E′ lateral (0.347; p = 0.009) remained independent predictors, while ESR trended (0.0178; p = 0.057). Discrimination was strongest for troponin I (AUC 0.930, 95% CI 0.726–0.933), followed by WBC (0.756), CRP (0.756), and ESR (0.723). Conclusions Admission troponin I provides the strongest predictive value for one-year myocardial impairment in myocarditis, with complementary contributions from WBC, CRP, and LV E/E′. These accessible measures support early risk stratification where advanced imaging is limited.

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