Heart-type fatty acid-binding proteins (H-FABP): a reliable tool for initial risk stratification of pulmonary embolism?

Abstract

The severity of pulmonary embolism (PE) ranges from asymptomatic to cardiogenic shock with corresponding short-term mortality between 2 and 95%. Whereas the former could be discharged early or managed entirely as outpatients using low-molecular-weight heparin, those with greater severity of PE require rapid echocardiography to evaluate for indications for immediate thrombolysis or embolectomy.2,3 However, most patients with PE fall between these two extremes. Patients with PE who do not initially present with life-threatening criteria are usually admitted to a hospital ward where those with intermediate risk might experience a life-threatening recurrent episode requiring emergent thrombolysis and critical care. Therefore, among patients with intermediate clinical severity, it is critical to accurately identify those at risk for adverse medical outcome. Despite recent advances in risk stratification, it remains difficult to assess the risk of short-term medical outcome and to elicit an appropriate management strategy at the time PE is diagnosed, particularly for patients with intermediate severity criteria.4 Severe dyspnoea, cyanosis, and syncope indicate life-threatening PE, and accentuated p2, tricuspid regurgitation murmur, or distended neck veins indicates acute right ventricular failure that is consistently associated with adverse short-term outcomes. On the ECG, T -wave inversion or a pseudoinfarction pattern (QR) in the anterior precordial leads indicates right ventricular dilation and dysfunction and are associated with adverse clinical outcome.5 Echocardiography has emerged as the principal tool for risk stratification in acute PE. Echocardiographic abnormalities (right ventricular hypokinesis, persistent pulmonary hypertension, patent foramen ovale, and free-floating right heart thrombus) rapidly and … *Corresponding author. Tel: +33 1 49 81 25 23; fax: +33 1 49 81 29 87. E-mail address : bertrand.renaud{at}hmn.aphp.fr