Circulation. 2002;106:1263-1268
Published online before print August 12, 2002, doi: 10.1161/01.CIR.0000028422.51668.A2
Published online before print August 12, 2002, doi: 10.1161/01.CIR.0000028422.51668.A2
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(Circulation. 2002;106:1263.)
© 2002 American Heart Association, Inc.
Clinical Investigation and Reports |
Importance of Cardiac Troponins I and T in Risk Stratification of Patients With Acute Pulmonary Embolism
From Georg-August-Universität Göttingen, Abteilung Kardiologie und Pneumologie (S.K., N.H.); Albert-Ludwigs-Universität Freiburg, Abteilung Kardiologie und Angiologie (A.G., S.J.); Albert-Ludwigs-Universität Freiburg, Abteilung Medizinische Biometrie und Informatik (M.O.); St Josefs Hospital Wiesbaden, Innere Abteilung (W.K.); and Georg-August-Universität Göttingen, Abteilung Klinische Chemie (L.B.), Germany.
Correspondence to Stavros Konstantinides, MD, Department of Cardiology and Pulmonary Medicine, Georg August University of Goettingen, Robert Koch Strasse 40, D-37075 Goettingen, Germany. E-mail skonstan{at}med.uni-goettingen.de
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 (
0.07 ng/mL) in 43 patients (41%), and cTnT (0.04 ng/mL) was elevated in 39 (37%). Elevation of cTnI or cTnT was significantly associated with echocardiographically detected right ventricular dysfunction (P=0.001 and P<0.05, 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 >1.5; cTnT >0.1 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 (P=0.019) or cTnT (P=0.038) 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.
Key Words: embolism • pulmonary heart disease • prognosis • echocardiography
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|
|
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|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
S. Z. Goldhaber and C. G. Elliott Acute Pulmonary Embolism: Part II: Risk Stratification, Treatment, and Prevention Circulation, December 9, 2003; 108(23): 2834 - 2838. [Full Text] [PDF]
|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
N. Kucher and S. Z. Goldhaber Cardiac Biomarkers for Risk Stratification of Patients With Acute Pulmonary Embolism Circulation, November 4, 2003; 108(18): 2191 - 2194. [Full Text] [PDF]
|
|
|
|
|
|
P. F. Fedullo and V. F. Tapson The Evaluation of Suspected Pulmonary Embolism N. Engl. J. Med., September 25, 2003; 349(13): 1247 - 1256. [Full Text] [PDF]
|
|
|
|
|
|
N. Kucher, D. Wallmann, A. Carone, S. Windecker, B. Meier, and O. M. Hess Incremental prognostic value of troponin I and echocardiography in patients with acute pulmonary embolism Eur. Heart J., September 2, 2003; 24(18): 1651 - 1656. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
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|
|
|
|
|
|
S. Z. Goldhaber Cardiac Biomarkers in Pulmonary Embolism Chest, June 1, 2003; 123(6): 1782 - 1784. [Full Text] [PDF]
|
|
|
|
|
|
P. Pruszczyk, A. Bochowicz, A. Torbicki, M. Szulc, M. Kurzyna, A. Fijalkowska, and A. Kuch-Wocial Cardiac Troponin T Monitoring Identifies High-Risk Group of Normotensive Patients With Acute Pulmonary Embolism Chest, June 1, 2003; 123(6): 1947 - 1952. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 British Thoracic Society guidelines for the management of suspected acute pulmonary embolism Thorax, June 1, 2003; 58(6): 470 - 483. [Full Text] [PDF]
|
|
|
|
|
|
N. Kucher, G. Printzen, and S. Z. Goldhaber Prognostic Role of Brain Natriuretic Peptide in Acute Pulmonary Embolism Circulation, May 27, 2003; 107(20): 2545 - 2547. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. ten Wolde, I.I. Tulevski, J.W.M. Mulder, M. Sohne, F. Boomsma, B.J.M. Mulder, and H.R. Buller Brain Natriuretic Peptide as a Predictor of Adverse Outcome in Patients With Pulmonary Embolism Circulation, April 29, 2003; 107(16): 2082 - 2084. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Kucher, G. Printzen, T. Doernhoefer, S. Windecker, B. Meier, and O. M. Hess Low Pro-Brain Natriuretic Peptide Levels Predict Benign Clinical Outcome in Acute Pulmonary Embolism Circulation, April 1, 2003; 107(12): 1576 - 1578. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Serum Troponin for Risk Stratification in PE Patients Journal Watch Cardiology, November 15, 2002; 2002(1115): 7 - 7. [Full Text]
|
|
|
|
 |
|
 Troponin Levels Are Elevated in Patients with PE. Now What? Journal Watch Emergency Medicine, November 13, 2002; 2002(1113): 3 - 3. [Full Text]
|
|
|
|
 |
|
 Serum Troponin for Risk Stratification in PE Patients Journal Watch (General), October 8, 2002; 2002(1008): 6 - 6. [Full Text]
|
|