title: Limited value of novel pulmonary embolism biomarkers in patients with coronary atherosclerosis.
abstract: BACKGROUND
  Recent research supports the efficacy of various plasma biomarkers in diagnosing pulmonary embolism (PE) including E-selectin, MMP-9, MPO, sVCAM-1, sICAM-1, adiponectin, hs-CRP and tPAI-1.
  
  
  OBJECTIVE
  We hypothesized that these biomarkers, which are affected in both venous and arterial thromboembolic diseases, have a limited potential of diagnosing PE in patients with concomitant coronary atherosclerosis, as assessed from a low-dose CT scan of the thorax, compared to patients without atherosclerosis.
  
  
  METHODS
  Consecutive patients suspected of PE were referred. All patients had a ventilation/perfusion single photon emission tomography (V/Q-SPECT), low-dose pulmonary CT, pulmonary multidetector computer tomography angiography, blood samples and ECG-gated cardiac CT performed the same day.
  
  
  RESULTS
  A total of 69 patients were included, of which 28 (41%) had PE. In patients without coronary calcium, MMP-9 and tPAI-1 were significantly elevated (P<0·042 and P<0·049) in patients diagnosed with PE. From the receiver operating curves, we chose a cut-off value for MMP-9 at 164·4 ng l(-1) , which yielded sensitivity, specificity, positive and negative predictive values of 63%, 78%, 71% and 70%, respectively. With a chosen cut-off value for tPAI-1 at 56·3 ng l(-1) , the sensitivity, specificity, positive and negative predictive values were 88%, 89%, 88% and 89%, respectively. In patients with coronary calcium, none of the biomarkers could discriminate between PE and no PE.
  
  
  CONCLUSIONS
  Plasma levels of tPAI-1 and MMP-9 are potentially useful in patients suspected of PE, however, not in the presence of the coronary atherosclerosis.
authors: Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Copenhagen University Hospital. ogoh@toyo.jp
authors: Henrik
authors: H
authors: Gutte
authors: Jann
authors: J
authors: Mortensen
authors: Anne M F
authors: AM
authors: Hag
authors: Claus V
authors: CV
authors: Jensen
authors: Ulrik S
authors: US
authors: Kristoffersen
authors: Louise
authors: L
authors: Brinth
authors: Andreas
authors: A
authors: Kjaer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood*; D016022:Case-Control Studies; D003324:Coronary Artery Disease / Q000097:blood / Q000150:complications*; D003718:Denmark; D005260:Female; D006801:Humans; D008297:Male; D020780:Matrix Metalloproteinase 9 / Q000097:blood; D008875:Middle Aged; D055420:Perfusion Imaging / Q000379:methods; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood; D011237:Predictive Value of Tests; D011379:Prognosis; D011655:Pulmonary Embolism / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D012372:ROC Curve; D012680:Sensitivity and Specificity; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed
chemical_list: D015415:Biomarkers; D017395:Plasminogen Activator Inhibitor 1; C051321:SERPINE1 protein, human; D020780:Matrix Metalloproteinase 9