Abstract 18214: Interpreting Troponin Elevation in Relation to Symptom Onset in Intermediate-Risk Pulmonary Embolism

Abstract

Background: Troponin dosage plays an increasingly important role in risk stratification in pulmonary embolism (PE), especially in patients (pts) without hemodynamic compromise. Troponin elevation in the setting of acute PE is of small magnitude and short duration and thus, can go unnoticed in pts referred late after symptom onset. Methods: Prospective, single-center registry of patients with confirmed intermediate-risk PE, defined as at least 1 echocardiographic finding indicating right ventricular (RV) dysfunction (RV/left ventricular end-diastolic diameter ratio * 1 in the 4-chamber view, paradoxical septal systolic motion or pulmonary hypertension defined as a RV/atrial gradient >30 mmHg), or a positive troponin test. We used a combined in-hospital endpoint defined as death, non-fatal recurrent PE, or residual pulmonary vascular obstruction (RPVO) >30% as measured by V/Q scan before discharge. Results: In total, 199 patients were included, average age 69±15, 56% women, 116 (58%) pts referred within ≤5 days after symptom onset, and 83 (42%) after >5 days, of whom 25 were referred after >15 days since symptom onset. All patients had at least 1 sign of RV dysfunction. Troponin elevation was observed in 78/116 pts (67.2%) treated within ≤5 days, and in 40/83 pts (48.2%) treated after >5 days (p=0.03). Sensitivity and specificity of troponin elevation to predict adverse outcome as defined above are shown in the table. Conclusion: Our results show that there is a significant relation between troponin elevation and symptom onset in patients with intermediate-risk PE. Time since symptom onset should be taken into consideration when interpreting troponin elevation in this population. Negative predictive value of troponin elevation is adequate in pts treated early (≤5 days) but is suboptimal in pts treated >5 days after symptom onset.