title: Prediction of adverse clinical outcome in patients with acute pulmonary embolism: evaluation of high-sensitivity troponin I and quantitative CT parameters.
abstract: OBJECTIVE
  To evaluate the accuracy of high-sensitivity-cardiac-troponin-I (hs-cTnI) and quantitative CT-parameters, alone and in combination, for predicting right-ventricular-dysfunction (RVD) and adverse clinical outcome in patients with acute pulmonary embolism (PE).
  
  
  METHODS
  65 patients with PE and hs-cTnI measurements within 24 h of CT were retrospectively included. RVD was assessed on CT by calculating right ventricular/left ventricular (RV/LV) diameter ratios on transverse sections (RV/LVtrans), four-chamber-views (RV/LV4ch), and RV/LV volume ratio (RV/LVvol). Pulmonary CTA-obstruction-scores (OS) (Qanadli, Mastora) were calculated. Receiver operator characteristic (ROC) analysis was performed to compare Hs-cTnI, RV/LV ratios, and OS for predicting adverse clinical outcome (i.e. intensive care treatment, death).
  
  
  RESULTS
  12 patients with PE had adverse clinical outcome and showed significantly higher RV/LV ratios and OS compared to those without. ROC analysis revealed a cutoff value of 0.042 ng/mL for hs-cTnI resulting in a sensitivity and specificity of 84% and 92% for predicting adverse clinical outcome, respectively. Elevated hs-cTnI was significantly associated with adverse clinical outcome. In a ROC analysis the AUC for the prediction of adverse clinical outcome of RV/LV4Ch, RV/LVvol, and hs-cTnI were 0.77, 0.76, and 0.71. The combination of hs-cTnI and RV/LV ratios increased the AUC for the prediction of adverse clinical outcome.
  
  
  CONCLUSIONS
  Hs-cTnI is associated with adverse clinical outcome in patients with acute PE. A combination of hs-cTnI with quantitative CT-parameters improves the prediction of adverse clinical outcome.
authors.affiliation: Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim-Heidelberg University, Germany. Paul.Apfaltrer@medma.uni-heidelberg.de
authors.forename: Paul
authors.initials: P
authors.lastname: Apfaltrer
authors.forename: Thomas
authors.initials: T
authors.lastname: Walter
authors.forename: Joachim
authors.initials: J
authors.lastname: Gruettner
authors.forename: Frank
authors.initials: F
authors.lastname: Weilbacher
authors.forename: Mathias
authors.initials: M
authors.lastname: Meyer
authors.forename: Thomas
authors.initials: T
authors.lastname: Henzler
authors.forename: Michael
authors.initials: M
authors.lastname: Neumaier
authors.forename: Stefan O
authors.initials: SO
authors.lastname: Schoenberg
authors.forename: Christian
authors.initials: C
authors.lastname: Fink
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011655:Pulmonary Embolism / Q000097:blood / Q000150:complications* / Q000175:diagnosis*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D019210:Troponin I / Q000097:blood*; D018497:Ventricular Dysfunction, Right / Q000097:blood / Q000175:diagnosis* / Q000209:etiology*; D055815:Young Adult
chemical_list: D015415:Biomarkers; D019210:Troponin I