title: Troponin I and right ventricular dysfunction for risk assessment in patients with nonmassive pulmonary embolism in the Emergency Department in combination with clinically based risk score.
abstract: To determine whether troponin I (cTnI) and right ventricular (RV) dysfunction predict adverse in-hospital outcomes in patients admitted to the Emergency Department (ED) with definite nonmassive pulmonary embolism (PE) independent of and in addition to a recently validated clinical prognostic risk score. From a pool of 168 patients with suspected PE, 89 had nonmassive PE confirmed by spiral lung angio-computed tomography. By the clinical prognostic score, in our study sample, 14% had very low risk; 17% had low risk, 20% had intermediate risk, whereas high risk and very high risk were identified in 29 and 20%, respectively. Prevalence of elevated cTnI (>0.1 microg/L, 57%) at admission was comparable among patients grouped by clinical prognostic score (P = NS); echocardiographic RV dysfunction (54%) was more prevalent with intermediate or high clinical risk score (P < 0.02). Increased cTnI predicted primary end-point (development of hemodynamic instability, overall 33 cases, 37%) independent of and in addition to the clinical risk class and RV dysfunction (P < 0.01 for interaction). Fatal events (12 cases, 14%, 5 definite, 7 possible PE-related) were predicted by higher clinical risk score (P < 0.05). In patients with nonmassive central PE admitted to the ED, increased cTnI contributed to identifying those with increased risk of development of hemodynamic instability independent of and in addition to a validated clinically based risk score.
authors.affiliation: Cardiology Unit, Ospedale dei Pellegrini, ASL-Napoli 1, Naples, Italy. vpalmier@med.cornell.edu
authors.forename: Vittorio
authors.initials: V
authors.lastname: Palmieri
authors.forename: Giovanni
authors.initials: G
authors.lastname: Gallotta
authors.forename: Domenico
authors.initials: D
authors.lastname: Rendina
authors.forename: Silvana
authors.initials: S
authors.lastname: De Bonis
authors.forename: Vittorio
authors.initials: V
authors.lastname: Russo
authors.forename: Alfredo
authors.initials: A
authors.lastname: Postiglione
authors.forename: Stefania
authors.initials: S
authors.lastname: Martino
authors.forename: Matteo Nicola Dario
authors.initials: MN
authors.lastname: Di Minno
authors.forename: Aldo
authors.initials: A
authors.lastname: Celentano
mesh_terms: D000328:Adult; D000368:Aged; D004452:Echocardiography; D005260:Female; D006305:Health Status Indicators; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D011655:Pulmonary Embolism / Q000097:blood / Q000209:etiology*; D018570:Risk Assessment; D019210:Troponin I / Q000097:blood*; D018497:Ventricular Dysfunction, Right / Q000097:blood / Q000150:complications*
chemical_list: D019210:Troponin I