Use of biomarkers or echocardiography in pulmonary embolism: the Swiss Venous Thromboembolism Registry.
BACKGROUND
Cardiac biomarkers and echocardiography for assessing right ventricular function are recommended to risk stratify patients with acute non-massive pulmonary embolism (PE), but it remains unclear if these tests are performed systematically in daily practice.


METHODS
Overall, 587 patients with acute non-massive PE from 18 hospitals were enrolled in the Swiss Venous Thromboembolism Registry (SWIVTER): 178 (30%) neither had a biomarker test nor an echocardiographic evaluation, 196 (34%) had a biomarker test only, 47 (8%) had an echocardiogram only and 166 (28%) had both tests.


RESULTS
Among the 409 (70%) patients with biomarkers or echocardiography, 210 (51%) had at least one positive test and 67 (16%) had positive biomarkers and right ventricular dysfunction. The ICU admission rates were 5.1% without vs. 5.6% with testing (P = 0.78), and thrombolysis or embolectomy were performed in 2.8% vs. 4.9%, respectively (P = 0.25). In multivariate analysis, syncope [odds ratio (OR): 3.49, 95% confidence interval (CI): 1.20-10.15; P = 0.022], tachycardia (OR: 2.31, 95% CI: 1.37-3.91; P = 0.002) and increasing age (OR: 1.02; 95% CI: 1.01-1.04; P < 0.001) were associated with testing of cardiac risk; outpatient status at the time of PE diagnosis (OR: 2.24, 95% CI: 1.49-3.36; P < 0.001), cancer (OR: 1.81, 95% CI: 1.17-2.79; P = 0.008) and provoked PE (OR: 1.58, 95% CI: 1.05-2.40; P = 0.029) were associated with its absence.


CONCLUSIONS
Although elderly patients and those with clinically severe PE were more likely to receive a biomarker test or an echocardiogram, these tools were used in only two-thirds of the patients with acute non-massive PE and rarely in combination.
Medical Department, Sanofi-Aventis (Suisse) SA, Meyrin 1217, Switzerland.
D
D
Spirk
T
T
Willenberg
D
D
Aujesky
M
M
Husmann
D
D
Hayoz
T
T
Baldi
A
A
Brugger
B
B
Amann-Vesti
I
I
Baumgartner
N
N
Kucher
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D004452:Echocardiography / Q000379:methods*; D017128:Embolectomy; D005260:Female; D006801:Humans; D008297:Male; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D012042:Registries; D018570:Risk Assessment; D013557:Switzerland / Q000453:epidemiology; D015912:Thrombolytic Therapy; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000150:complications / Q000175:diagnosis*
D015415:Biomarkers