title: Biomarkers in pulmonary embolism.
abstract: OBJECTIVE
  Controversy exists about the precise role of thrombolytic therapy in normotensive patients with pulmonary embolism. To resolve this controversy two major questions must be addressed. First, can a subgroup of normotensive pulmonary embolism patients with a high risk for adverse outcomes, such as in-hospital mortality or early recurrent venous thromboembolism, be identified? Second, is there convincing evidence that the benefits of more aggressive therapy counterbalance its risks?Troponin I and T as well as brain natriuretic peptide (BNP) have recently been introduced as promising tools in the risk assessment of patients with pulmonary embolism.
  
  
  RESULTS
  The studies in series of patients with pulmonary embolism showed prevalences of elevated cardiac biomarkers of 16 to 84%. Positive predictive values for in-hospital mortality varied from 6 to 44%, whereas negative predictive values for uneventful outcome were above 93% in all studies.
  
  
  CONCLUSIONS
  Although a correlation between elevated biomarkers and in-hospital mortality in pulmonary embolism patients is present in most of the studies, the positive predictive value appears to be insufficient to extend the indication for thrombolytic therapy to all patients with elevated biomarkers. Future research is necessary to show whether combining different biomarkers with echocardiography is more useful.
authors.affiliation: Academic Medical Center, Department of Vascular Medicine, Amsterdam, The Netherlands. m.sohne@amc.uva.nl
authors.forename: Maaike
authors.initials: M
authors.lastname: Söhne
authors.forename: Marije
authors.initials: M
authors.lastname: Ten Wolde
authors.forename: Harry R
authors.initials: HR
authors.lastname: Büller
mesh_terms: D015415:Biomarkers / Q000378:metabolism*; D006801:Humans; D009211:Myoglobin / Q000378:metabolism; D020097:Natriuretic Peptide, Brain / Q000378:metabolism; D011379:Prognosis; D011655:Pulmonary Embolism / Q000378:metabolism / Q000473:pathology*; D019210:Troponin I / Q000378:metabolism; D020107:Troponin T / Q000378:metabolism
chemical_list: D015415:Biomarkers; D009211:Myoglobin; D019210:Troponin I; D020107:Troponin T; D020097:Natriuretic Peptide, Brain