Troponin I and risk stratification of patients with acute nonmassive pulmonary embolism (original) (raw)
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Early Risk Stratification Of Patients With Acute Pulmonary Embolism: Role Of Cardiac Troponin I
abstract Background: The early assessment of risk and appropriate management of patients with acute pulmonary embolism (APE) remains a challenge. Objective: This study is planned to evaluate the prognostic significance of cardiac troponin I (cTnI) levels in predicting in-hospital haemodynamic instability, complicated clinical course and mortality in patients with APE. Patients and methods: This study included 42 patients with APE who were haemodynamically stable at the time of admission. According to the level of cTnI, the patients were divided into two groups. The first group involved patients with APE and elevated cTnI levels (cTnI positive group), it included 18 patients (42%) with a mean cTnI value of 0.39±0.23 ng/ml, a range of 0.08 – 0.9 ng/ml and a median of 0.36 ng/ml. the second group involved patients with APE and normal cTnI levels (cTnI negative group) , it included 24 patients with normal cTnI levels (<0.01 ng/ml). All patients were subjected to history taking and complete clinical examination including measurement of blood pressure, assessment of partial pressures of O 2 (PaO 2) and carbon dioxide (PaCO2), D-dimer, total creatine kinase (CK) and CK-MB isoenzyme and cardiac troponin I,. All patients were subjected to electrocardiography (ECG) and echocardiography.Pulmonary embolism was diagnosed by helical computed tomography(CT) angiography.
The effect of troponin values on prognosis in acute pulmonary embolism
International Journal of Clinical Trials, 2020
Background: The objective of this study is to evaluate the clinical usefulness of cardiac troponin levels in acute pulmonary thromboembolism (PTE) prognosis.Methods: Thorax computed tomography (CT) angiography was performed and reported by the radiologist as pulmonary embolism and 193 patients older than 18 years of age who were considered PTE by the physician of chest diseases were included in the study. Patients diagnosed with PTE were divided into two groups as those who died within 30 days and did not die within 30 days. As a result of the statistically significant relationship between troponin and mortality, receiver operating characteristic (ROC) analysis was performed to determine the prognosis level of troponin and appropriate sensitivity and specificity cut-off values were determined.Results: We determined that troponin levels of patients diagnosed with PTE in the emergency department were statistically significantly higher in the group with mortality (p=0.031). Since the a...
The American Journal of Emergency Medicine, 2007
The purpose of this study was to evaluate the value of elevated cardiac troponin I (cTnI) for prediction of complicated clinical course and in-hospital mortality in patients with confirmed acute pulmonary embolism (PE). Methods and Results: This study was a retrospective chart review of patients diagnosed as having PE, in whom cTnI testing was obtained at emergency department (ED) presentation between January 2002 and April 2006. Clinical characteristics; echocardiographic right ventricular dysfunction; inhospital mortality; and adverse clinical events including need for inotropic support, mechanical ventilation, and thrombolysis were compared in patients with elevated cTnI levels vs patients with normal cTnI levels. One hundred sixteen patients with PE were identified, and 77 of them (66%) were included in the study. Thirty-three patients (42%) had elevated cTnI levels. Elevated cTnI levels were associated with inhospital mortality (P = .02), complicated clinical course (P b .001), and right ventricular dysfunction (P b .001). In patients with elevated cTnI levels, inhospital mortality (odds ratio [OR], 3.31; 95% confidence interval [CI], 1.82-9.29), hypotension (OR, 7.37; 95% CI, 2.31-23.28), thrombolysis (OR, 5.71; 95% CI, 1.63-19.92), need for mechanical ventilation (OR, 5.00; 95% CI, 1.42-17.57), and need for inotropic support (OR, 3.02; 95% CI, 1.03-8.85) were more prevalent. The patients with elevated cTnI levels had more serious vital parameters (systolic blood pressure, pulse, and oxygen saturation) at ED presentation. Conclusion: Our results indicate that elevated cTnI levels are associated with higher risk for inhospital mortality and complicated clinical course. Troponin I may play an important role for the risk assessment
International Journal of Cardiology, 2013
Background: Although cardiac troponin elevation during acute pulmonary embolism (PE) predicts in-hospital death, its long-term prognostic significance, and the role of troponin-T concentration in this prediction, is unknown. Moreover, its use in acute PE in elderly populations with multiple comorbidities is not well described. Methods: Consecutive patients presenting with confirmed PE to a tertiary hospital between 2000 and 2007 with troponin-T measured were identified retrospectively and their outcomes tracked from a statewide death registry. Results: There were 577 patients, (47% male) with a mean age (±standard deviation) of 70.1 ±15.2 years, of whom 19 died during index admission. Of the 558 patients who survived to discharge, 186 patients died during a mean follow-up of 3.8± 2.4 years. There were 187 (32%) patients with elevated troponin-T (≥0.01 μg/L). Troponin-T concentration was significantly and independently associated with in-hospital and long-term mortality whether analyzed as a continuous or categorical variable (pb 0.001). However, different cut-points were required to optimally predict in-hospital and post-discharge long-term mortality in multivariate analysis. Troponin-T ≥0.01 μg/L was not an independent predictor of in-hospital or post-discharge survival. A cut-point of troponin-T≥ 0.03 μg/L was required to independently predict in-hospital death (p = 0.03), and troponin-T ≥0.1 μg/L was required to independently predict long-term mortality (hazard ratio 2.3, 95% confidence interval 1.4-3.8, p=0.001). Conclusions: Troponin-T elevation during acute PE shows a concentration-dependent relationship with acute and long-term outcome. Concentrations of troponin-T well above the threshold for detection may be required to independently contribute to prediction of outcome in elderly populations with acute PE.
Circulation, 2002
Background-Assessment of risk and appropriate management of patients with acute pulmonary embolism (PE) remains a challenge. Cardiac troponins I (cTnI) and T (cTnT) are reliable indicators of myocardial injury and may be associated with right ventricular dysfunction in PE. Methods and Results-The present prospective study included 106 consecutive patients with confirmed acute PE. cTnI was elevated (Ն0.07 ng/mL) in 43 patients (41%), and cTnT (Ն0.04 ng/mL) was elevated in 39 (37%). Elevation of cTnI or cTnT was significantly associated with echocardiographically detected right ventricular dysfunction (Pϭ0.001 and PϽ0.05, respectively). Moreover, a significant correlation was found between elevation of cTnI or cTnT and the two major end points overall mortality and complicated in-hospital course. The negative predictive value of cardiac troponins for major clinical events was 92% to 93%. Importantly, there was obvious escalation of in-hospital mortality, the rate of complications, and the incidence of recurrent PE, when patients with high troponin concentrations (cTnI Ͼ1.5; cTnT Ͼ0.1 ng/mL) were compared with those with only moderately elevated levels (cTnI, 0.07 to 1.5; cTnT, 0.04 to 0.1 ng/mL). Logistic regression analysis confirmed that the mortality risk (OR) was significantly elevated only in patients with high cTnI (Pϭ0.019) or cTnT (Pϭ0.038) levels. Furthermore, the risk of a complicated in-hospital course was almost 5 times higher (15.47 versus 3.16) in the high-cTnI group compared with patients with moderate cTnI elevation. Conclusions-Our results indicate that cTnI and cTnT may be a novel, particularly useful tool for optimizing the management strategy in patients with acute PE.
Increased cardiac troponin I on admission predicts in-hospital mortality in acute pulmonary embolism
Heart, 2004
Background: To investigate the frequency of cardiac troponin I (cTnI) increases in patients with pulmonary embolism (PE) and to assess the correlation between this finding, the clinical presentation, and outcomes. Methods: Consecutive patients admitted to the coronary care unit with acute PE were prospectively enrolled between January 2000 and December 2001. cTnI was sequentially determined. Various cut off concentrations were analysed, but patients were categorised prospectively as having increased or no increased cTnI based on a cut off concentration of 0.6 ng/ml. The main outcome measure was in-hospital mortality. Results: On admission, 14 of the 48 patients (29%) had cTnI concentrations greater than the receiver operating characteristic curve value used to diagnose acute myocardial infarction (. 0.6 ng/ml). Subsequently, six patients developed increases for an overall prevalence of 42% (20 of 42). The prevalence was higher when lower cut off concentrations were used: 73% (35 of 48) at the 99th centile and 60% (29 of 48) at the 10% coefficient of variability. Increased cTnI . 0.6 ng/ml was associated with a slower oxygen saturation (86 % v 93 (4)%, p , 0.0001) and more frequent involvement of the main pulmonary arteries as assessed by spiral computed tomography (100% v 60%, p = 0.022). In-hospital mortality was 36% (5 of 14) of patients with increases . 0.6 ng/ml v 3% (1 of 42) of patients with lower concentrations (p = 0.008). Increased cTnI . 0.6 ng/ml on admission was the most powerful predictor of mortality (p = 0.046). Conclusions: In high risk patients with acute PE, cTnI was frequently detected on admission. It was the strongest independent predictor of mortality.
Prognostic Value of Troponins in Acute Pulmonary Embolism: A Meta-Analysis
Circulation, 2007
Background-Whether elevated serum troponin levels identify patients with acute pulmonary embolism at high risk of short-term mortality or adverse outcome is undefined. Methods and Results-We performed a meta-analysis of studies in patients with acute pulmonary embolism to assess the prognostic value of elevated troponin levels for short-term death and adverse outcome events (composite of death and any of the following: shock, need for thrombolysis, endotracheal intubation, catecholamine infusion, cardiopulmonary resuscitation, or recurrent pulmonary embolism). Unrestricted searches of MEDLINE and EMBASE bibliographic databases from January 1998 to November 2006 were performed using the terms "troponin" and "pulmonary embolism." Additionally, review articles and bibliographies were manually searched. Cohort studies were included if they had used cardiac-specific troponin assays and had reported on short-term death or adverse outcome events. A random-effects model was used to pool study results; funnel-plot inspection was done to evaluate publication bias; and I 2 testing was used to test for heterogeneity. Data from 20 studies ) were included in the analysis. Overall, 122 of 618 patients with elevated troponin levels died (19.7%; 95% confidence interval [CI], 16.6 to 22.8) compared with 51 of 1367 with normal troponin levels (3.7%; 95% CI, 2.7 to 4.7). Elevated troponin levels were significantly associated with short-term mortality (odds ratio [OR], 5.24; 95% CI, 3.28 to 8.38), with death resulting from pulmonary embolism (OR, 9.44; 95% CI, 4.14 to 21.49), and with adverse outcome events (OR, 7.03; 95% CI, 2.42 to 20.43). Elevated troponin levels were associated with a high mortality in the subgroup of hemodynamically stable patients (OR, 5.90; 95% CI, 2.68 to 12.95). Results were consistent for troponin I or T and prospective or retrospective studies. Conclusions-Elevated troponin levels identify patients with acute pulmonary embolism at high risk of short-term death and adverse outcome events. (Circulation. 2007;116:427-433.)