Cardiac troponin T monitoring identifies high-risk group of normotensive patients with acute pulmonary embolism.
OBJECTIVE
Indications for thrombolysis in normotensive patients with pulmonary embolism (PE), based on the presence of right ventricular (RV) overload during transthoracic echocardiography (TTE), are controversial. We checked whether the monitoring of cardiac troponin T (cTnT) might help in risk stratification by detecting patients with RV myocardial injury.


METHODS
We studied 64 normotensive patients (30 women and 34 men) with a mean (+/- SD) age of 61.3 +/- 17 years and PE, who had undergone TTE for the assessment of RV overload. Plasma cTnT levels were measured quantitatively (detection limit, > 0.01 ng/mL) at hospital admission, and subsequently three times at 6-h intervals. Heparin therapy alone was used in 87.5% of patients, while 12.5% of patients received thrombolysis.


RESULTS
cTnT was detected in 50% of patients. All eight in-hospital deaths occurred in the troponin-positive group, however, in one case the results of the first three assays had been negative. Elevated plasma cTnT increased the risk of PE-related death (odds ratio [OR], 21; 95% confidence interval [CI], 1.2 to 389). Increased age and elevated tricuspid regurgitant jet velocity, but not RV diameter/left ventricle diameter ratio, influenced the hospital mortality rate. Increased cTnT level was the only parameter predicting 15 in-hospital clinical adverse events (ie, death, thrombolysis, cardiopulmonary resuscitation, and IV use of catecholamine agents) [OR, 24.1; 95% CI, 2.9 to 200].


CONCLUSIONS
Patients with PE and elevated cTnT levels detected during repetitive assays are at a significant risk of a complicated clinical course and fatal outcome.
Pruszczyk
Piotr
P
Department of Internal Medicine and Hypertension, Medical University of Warsaw, Warsaw, Poland.
Bochowicz
Anna
A
Torbicki
Adam
A
Szulc
Marcin
M
Kurzyna
Marcin
M
Fijałkowska
Anna
A
Kuch-Wocial
Agnieszka
A
D000208:Acute Disease; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D015912:Thrombolytic Therapy; D020107:Troponin T / Q000097:blood*; D018497:Ventricular Dysfunction, Right / Q000150:complications / Q000175:diagnosis
D020107:Troponin T