(Circulation. 2000;102:211.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Independent Prognostic Value of Cardiac Troponin T in Patients With Confirmed Pulmonary Embolism
From Medizinische Klinik II, Medizinische Universität zu Lübeck, Germany.
Correspondence to Prof Hugo A Katus, Medizinische Klinik II, Medizinische Universität zu Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany. E-mail giannits{at}medinf.mu-luebeck.de
Background—Cardiac troponin T (cTnT) is a sensitive and specific marker, allowing the detection of even minor myocardial cell injury. In patients with severe pulmonary embolism (PE), myocardial ischemia may lead to progressive right ventricular dysfunction. It was therefore the purpose of this study to test the presence of cTnT and its prognostic implications in patients with confirmed PE.
Methods and Results—Fifty-six consecutive patients with confirmed
PE were enrolled in this prospective study. PE was confirmed by
pulmonary angiography, lung scan, or
echocardiography and subsidiary analyses.
Severity of PE was assessed by a clinical scoring system, and cTnT was
measured within 12 hours after admission. cTnT was elevated (
0.1
µg/L) in 18 (32%) patients with massive and moderate PE but not in
patients with small PE. In-hospital death (odds ratio 29.6, 95% CI 3.3
to 265.3), prolonged hypotension and cardiogenic shock (odds ratio
11.4, 95% CI 2.1 to 63.4), and need for resuscitation (odds ratio
18.0, 95% CI 2.6 to 124.3) were more prevalent in patients with
elevated cTnT. cTnT-positive patients more often needed inotropic
support (odds ratio 37.6, 95% CI 5.8 to 245.6) and mechanical
ventilation (odds ratio 78.8, 95% CI 9.5 to 653.2). After adjustment,
cTnT remained an independent predictor of 30-day mortality (odds ratio
15.2, 95% CI 1.22 to 190.4).
Conclusions—cTnT may improve risk stratification in patients with PE and may aid in the identification of patients in whom a more aggressive therapy may be warranted.
Key Words: embolism • pulmonary heart disease • coronary disease
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