title: Elevated cardiac biomarkers with normal right ventricular size indicate an unlikely diagnosis of acute pulmonary embolism in stable patients.
abstract: The purpose of this investigation is to assess the prevalence of elevated cardiac biomarkers, with or without estimates of right ventricular (RV) size, in stable patients with acute pulmonary embolism (PE). Our hypothesis is that the combination of high levels of cardiac troponin I (cTnI), high creatine kinase isoenzyme MB (CK-MB), and normal size RV are sufficiently uncommon in stable patients with PE to make the diagnosis of PE unlikely. Retrospective review showed a high cTnI plus high CK-MB in 20 (3.4%) of 585 stable patients with acute PE. A high cTnI plus high CK-MB with normal RV size was shown in 5 (1.9%) of 264 patients. In stable patients with such findings, therefore, PE is unlikely and other diagnoses, particularly acute coronary syndrome, should be considered before pursuing a diagnosis of PE.
authors.affiliation: Department of Internal Medicine, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA. steinp@trinity-health.org
authors.forename: Paul D
authors.initials: PD
authors.lastname: Stein
authors.forename: Muhammad
authors.initials: M
authors.lastname: Janjua
authors.forename: Fadi
authors.initials: F
authors.lastname: Matta
authors.forename: Fadel
authors.initials: F
authors.lastname: Jaweesh
authors.forename: Ahmed
authors.initials: A
authors.lastname: Alrifai
authors.forename: Abdo Y
authors.initials: AY
authors.lastname: Yaekoub
authors.forename: Haroon L
authors.initials: HL
authors.lastname: Chughtai
authors.forename: John F
authors.initials: JF
authors.lastname: Cotant
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D052279:Creatine Kinase, MB Form / Q000097:blood*; D004452:Echocardiography; D005260:Female; D006321:Heart / Q000033:anatomy & histology*; D006352:Heart Ventricles / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D015995:Prevalence; D011655:Pulmonary Embolism / Q000097:blood* / Q000175:diagnosis / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D019210:Troponin I / Q000097:blood*
chemical_list: D015415:Biomarkers; D019210:Troponin I; D052279:Creatine Kinase, MB Form