title: Impact of cancer on the effectiveness of cardiac Troponin I to predict right ventricular dysfunction in acute pulmonary embolism.
abstract: BACKGROUND
  Deep vein thrombosis (DVT) and pulmonary embolism (PE) are connected with a poor outcome in cancer patients. We aimed to investigate the impact of cancer on the effectiveness of cardiac Troponin I (cTnI) to predict right ventricular dysfunction (RVD) in acute PE.
  
  
  METHODS
  We retrospectively analyzed the data of 182 patients with confirmed PE. PE patients were subdivided into two groups: (i) with concomitant active cancer disease or history of cancer, and (ii) without known cancer. Receiver operating characteristic (ROC) curves with area under the curve (AUC) was calculated for cTnI predicting RVD and related cut-off levels for both groups.
  
  
  RESULTS
  Thirty-seven PE patients (20.3%) had an active cancer disease or a history of cancer. In contrast, 145 (79.7%) of the included PE patients did not have a known cancer disease or a history of cancer. In the PE group with cancer, analysis of the ROC curve showed an AUC of 0.76 for cTnI predicting RVD with an optimal cut-off value of 0.04 ng/mL; the risk of misclassification was 25.0%. In the PE group without cancer, AUC was 0.81 for cTnI predicting RVD with an optimal cut-off value of 0.015 ng/mL; the risk of misclassification was 24.9%.
  
  
  CONCLUSIONS
  cTnI is effective for predicting RVD in PE patients with and without cancer. However, the effectiveness of cTnI to predict RVD was higher in PE patients without cancer than in those with cancer or a history of cancer.
authors.affiliation: Department of Medicine II, University Medical Center Mainz, Johannes Gutenberg-University Mainz Mainz, Germany ; Center for thrombosis and hemostasis, University Medical Center Mainz, Johannes Gutenberg-University Mainz Mainz, Germany.
authors.forename: Karsten
authors.initials: K
authors.lastname: Keller
authors.affiliation: Department of Medicine II, University Medical Center Mainz, Johannes Gutenberg-University Mainz Mainz, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Geyer
authors.affiliation: Department of internal medicine, St. Vincenz and Elisabeth Hospital Mainz (KKM) Mainz, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Beule
authors.affiliation: Department of Medicine II, University Medical Center Mainz, Johannes Gutenberg-University Mainz Mainz, Germany ; Center for thrombosis and hemostasis, University Medical Center Mainz, Johannes Gutenberg-University Mainz Mainz, Germany.
authors.forename: Meike
authors.initials: M
authors.lastname: Coldewey
authors.affiliation: Department of Radiology and Nuclear medicine, Catholic Clinic Mainz (KKM) Mainz, Germany ; Department of Diagnostic and Interventional Radiology, University Clinic, Johann Wolfgang Goethe-University Frankfurt/Main Mainz, Germany.
authors.forename: Jörn Oliver
authors.initials: JO
authors.lastname: Balzer
authors.affiliation: Department of internal medicine, St. Vincenz and Elisabeth Hospital Mainz (KKM) Mainz, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Dippold
keywords: Cancer; cardiac troponin; pulmonary embolism; right ventricular dysfunction; risk stratification