title: Heart-type fatty acid-binding protein and myocardial creatine kinase enable rapid risk stratification in normotensive patients with pulmonary embolism.
abstract: Risk assessments of hemodynamically stable patients with pulmonary embolisms (PE) remain challenging. In this context heart-type fatty acid-binding protein (H-FABP), creatine kinase isoenzyme MB (CK-MB), and troponin I (TnI) may hold prognostic utility for patients with pulmonary embolism.
  
  
  
  We included 161 consecutive normotensive (systolic blood pressure above 90 mm Hg) patients with confirmed PE to study the combined utility of echocardiographic signs of right ventricular dysfunction and several biomarkers (TnI, CK-MB, H-FABP). The primary endpoint was defined as death within 30 days after admission to the hospital.
  
  
  
  Elevated biomarkers were measured in 26 patients (16.1%) for HFABP, in 66 (41%) for TnI and in 41 (25.5%) for CK-MB. Echocardiography revealed right ventricular dysfunction (RVD) in 99 (61.5%) patients. Overall, 16 patients (9.9%) died within the study period. In the H-FABP positive group 15 (57.7%) patients died compared to 13 (19.7%) patients in the TnI positive group and 15 (37.5%) patients in the CK-MB positive group (H-FABP positive vs TnI positive patients, P< .001; H-FABP positive vs CK-MB positive patients P= .13; CK-MB positive vs TnI positive patients P= .07). All elevated biomarkers correlated with the primary endpoint with H-FABP being strongly, CK-MB intermediately and TnI weakly associated with short term death (H-FABP r= 0.701, P< .001; CK-MB r= 0.486, P< .001; TnI r= 0.272, P= .001). In multivariate logistic regression analysis, a positive H-FABP test (OR 27.1, 95% CI 2.1-352.3, P= .001), elevated CK-MB levels (OR 5.3, 95% CI 1.3-23.3, P= .002) and a low systolic blood pressure on admission (OR 0.8, 95% CI 0.8-0.9, P< .001) emerged as independent predictors of 30-day mortality.
  
  
  
  Both H-FABP and CK-MB are associated with short term mortality in normotensive PE patients and could be advantageous for risk stratification in this intermediate risk group.
authors.affiliation: University of Technology Dresden, Department of Cardiology, Medical Clinic, Fetscherstr, 76, Dresden 01307, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Langer
authors.affiliation: University of Technology Dresden, Department of Cardiology, Medical Clinic, Fetscherstr, 76, Dresden 01307, Germany. Electronic address: mathias.forkmann@gmx.net.
authors.forename: Mathias
authors.initials: M
authors.lastname: Forkmann
authors.affiliation: University of Technology Dresden, Department of Cardiology, Medical Clinic, Fetscherstr, 76, Dresden 01307, Germany.
authors.forename: Utz
authors.initials: U
authors.lastname: Richter
authors.affiliation: University of Technology Dresden, Department of Cardiology, Medical Clinic, Fetscherstr, 76, Dresden 01307, Germany.
authors.forename: Anne-Kathrin
authors.initials: AK
authors.lastname: Tausche
authors.affiliation: University of Technology Dresden, Department of Cardiology, Medical Clinic, Fetscherstr, 76, Dresden 01307, Germany.
authors.forename: Krunoslav
authors.initials: K
authors.lastname: Sveric
authors.affiliation: University of Technology Dresden, Department of Cardiology, Medical Clinic, Fetscherstr, 76, Dresden 01307, Germany.
authors.forename: Marian
authors.initials: M
authors.lastname: Christoph
authors.affiliation: University of Technology Dresden, Department of Cardiology, Medical Clinic, Fetscherstr, 76, Dresden 01307, Germany.
authors.forename: Karim
authors.initials: K
authors.lastname: Ibrahim
authors.affiliation: University of Technology Dresden, Department of Cardiology, Medical Clinic, Fetscherstr, 76, Dresden 01307, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Günther
authors.affiliation: University of Technology Dresden, Department of Cardiology, Medical Clinic, Fetscherstr, 76, Dresden 01307, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Kolschmann
authors.affiliation: University of Technology Dresden, Department of Cardiology, Medical Clinic, Fetscherstr, 76, Dresden 01307, Germany.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Boscheri
authors.affiliation: University of Technology Dresden, Department of Cardiology, Medical Clinic, Fetscherstr, 76, Dresden 01307, Germany.
authors.forename: Peggy
authors.initials: P
authors.lastname: Barthel
authors.affiliation: University of Technology Dresden, Department of Cardiology, Medical Clinic, Fetscherstr, 76, Dresden 01307, Germany.
authors.forename: Ruth H
authors.initials: RH
authors.lastname: Strasser
authors.affiliation: University of Technology Dresden, Department of Cardiology, Medical Clinic, Fetscherstr, 76, Dresden 01307, Germany.
authors.forename: Carsten
authors.initials: C
authors.lastname: Wunderlich
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure / Q000502:physiology; D052279:Creatine Kinase, MB Form / Q000097:blood*; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins / Q000097:blood*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000097:blood* / Q000401:mortality / Q000503:physiopathology; D018570:Risk Assessment / Q000379:methods; D019210:Troponin I / Q000097:blood; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis / Q000401:mortality
chemical_list: D015415:Biomarkers; C493408:FABP3 protein, human; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins; D019210:Troponin I; D052279:Creatine Kinase, MB Form
keywords: H-FABP; Pulmonary embolism; Risk stratification