Predictive value of troponins and simplified pulmonary embolism severity index in patients with normotensive pulmonary embolism

Savas Ozsu,Asim Orem,Huseyin Yaman,Yilmaz Bulbul,Yasin Abul,Tevfik Ozlu,Funda Oztuna

doi:10.1186/2049-6958-8-34

Savas Ozsu, Asim Orem + Show 5 more

Open Access

https://doi.org/10.1186/2049-6958-8-34

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Abstract

BackgroundTo investigate whether 2 cardiac troponins [conventional troponin-T(cTnT) and high sensitive troponin-T(hsTnT)] combined with simplified pulmonary embolism severity index (sPESI), or either test alone are useful for predicting 30-day mortality and 6 months adverse outcomes in patients with normotensive pulmonary embolism(PE).MethodsThe prospective study included 121 consecutive patients with normotensive PE confirmed by computerized tomographic(CT) pulmonary angiography. The primary end point of the study was the 30-day all-cause mortality. The secondary end point included the 180-day all-cause mortality, the nonfatal symptomatic recurrent PE, or the nonfatal major bleeding.ResultsOverall, 16 (13.2%) out of 121 patients died during the first month of follow up. The predefined hsTnT cutoff value of 0.014 ng/mL combined with a sPESI ≥1 'point(s) were the most significant predictor for 30-day mortality [OR: 27.6 (95% CI: 3.5–217) in the univariate analysis. Alone, sPESI ≥1 point(s) had the highest negative predictive value for both 30-day all-cause mortality and 6-months adverse outcomes,100% and 91% respectively.ConclusionsThe hsTnT assay combined with the sPESI may provide better predictive information than the cTnT assay for early death of PE patients. Low sPESI (0 points) may be used for identifying the outpatient treatment for PE patients and biomarker levels seem to be unnecessary for risk stratification in these patients.

Highlights

To investigate whether 2 cardiac troponins [conventional troponin-T(cTnT) and high sensitive troponin-T(hsTnT)] combined with simplified pulmonary embolism severity index, or either test alone are useful for predicting 30-day mortality and 6 months adverse outcomes in patients with normotensive pulmonary embolism(PE)
The Pulmonary Embolism Severity Index(PESI) is one of the validated scores used on admission for estimating the 30-day mortality [7]
European Society of Cardiology(ESC) guidelines recommend a risk stratification according to the presence of hypotension/shock, right ventricular dysfunction

Summary

Introduction

To investigate whether 2 cardiac troponins [conventional troponin-T(cTnT) and high sensitive troponin-T(hsTnT)] combined with simplified pulmonary embolism severity index (sPESI), or either test alone are useful for predicting 30-day mortality and 6 months adverse outcomes in patients with normotensive pulmonary embolism(PE). The Pulmonary Embolism Severity Index(PESI) is one of the validated scores used on admission for estimating the 30-day mortality [7]. Laboratory biomarkers, cardiac troponins, have been shown to identify patients with a high risk for mortality and an unfavourable prognosis during the acute phase of PE [10]. A very low amount of troponin can be detected in the blood of the general population with currently available highly sensitive assays and these assays have been reported to produce measures that relate to adverse cardiovascular outcomes [8,11,12]. Elevated troponin levels have been reported in various chronic diseases apart from acute myocardial infarctions, including diabetes and chronic renal disease [10,12]

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