Cardiac Troponin T Monitoring Identifies High-Risk Group of Normotensive Patients With Acute Pulmonary Embolisma

Pruszczyk, Piotr; Bochowicz, Anna; Torbicki, Adam; Szulc, Marcin; Kurzyna, Marcin; Fijałkowska, Anna; Kuch-Wocial, Agnieszka

doi:10.1378/chest.123.6.1947

Cited by 202 publications

(119 citation statements)

References 18 publications

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“…We have previously shown that acute myocardial infarction and ischemia can occur in sickle cell disease, independent of the acute chest syndrome [9][10][11][12]. Acute and chronic pulmonary hypertension have been shown to be associated with elevated troponin levels, indicating a poorer prognosis; however, the levels reported were small, possibly indicating leakage from a compromised right ventricle, in contrast to the levels in our cases which are compatible with significant tissue injury [13][14][15].…”

Section: Discussioncontrasting

confidence: 59%

Myocardial injury or infarction associated with fat embolism in sickle cell disease: A report of three cases with survival

et al. 2005

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Section: Discussioncontrasting

confidence: 59%

Myocardial injury or infarction associated with fat embolism in sickle cell disease: A report of three cases with survival

et al. 2005

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“…The rate of elevated troponin in haemodynamically stable patients with acute PE varies between 21-50% (20)(21)(22). In our study, we found 37% increase in the level of cTn-T.…”

Section: Discussionsupporting

confidence: 45%

Relationship between cardiac troponin-T and right ventricular Tei index in patients with hemodynamically stable pulmonary embolism: an observational study

Özsu¹,

Kırış²,

Bülbül³

et al. 2012

Anadolu Kardiyol Derg

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Objective: The role of increased troponin level in risk stratification of acute pulmonary embolism (PE) is well documented. However, relation between right ventricular (RV) myocardial performance (Tei) index and cardiac troponin-T (cTn-T) has not been well investigated. The purpose of this observational prospective study was to assess the relationship between the RV Tei index and cTn-T in patients with acute normotensive PE. Methods: Thirty-eight patients with acute PE diagnosed by computed spiral tomography pulmonary angiography were enrolled to this prospective observational study. All study population underwent a comprehensive echocardiographic study including tissue Doppler imaging within first 12 hours of admission. cTn-T levels were measured on admission. Follow-up echocardiography was performed routinely at the 7 th day of hospitalization. Echocardiographic evaluation was repeated at 90 days in patients with insufficient improvement of RV Tei index. The difference between the baseline and follow-up data was analyzed using the paired sample t-test or Wilcoxon test according to normality of distribution. Results: The mean of the RV Tei index was 0.46±0.14 and the mean systolic pulmonary artery pressure (sPAP) was 40±20 mmHg. Increased cTn-T level was detected in 37% of the patients (normal value 0.01< ng/mL). Significant correlations were observed between RV Tei index and sPAP with cTn-T levels (r=0.467 and r=0.468, p<0.001, respectively). In logistic regression analysis, RV Tei index was associated with positive cTn-T values (OR-136, 95% CI: 1.3-14657, p=0.039). After the anticoagulant treatment, RV Tei index and sPAP were significantly improved. Conclusion: RV Tei index is frequently impaired in patients with acute PE and a significant recovery is seen after the treatment. Therefore, RV Tei index may be used both the diagnosis of RV dysfunction and the assessment of treatment effectiveness. RV Tei index is may predict myocardial injury in PE. Yöntemler: Prospektif gözlemsel bu çalışmaya, bilgisayarlı spiral tomografik pulmoner anjiyografi ile tanısı konulan 38 PE hastası dahil edildi. Tüm çalışma popülâsyonuna, hastaneye kabulün ilk 12 saati içinde, doku Doppler görüntülemeyi içeren kapsamlı bir ekokardiyografik inceleme yapıldı. cTn-T seviyesi hastaneye kabulde ölçüldü. Hastanedeki tedavinin yedinci gününde rutin olarak takip ekokardiyografisi yapıldı. SV Tei indeksinde düzelme olmayan hastaların ekokardiyografisi doksanıncı günde tekrarlandı. Başlangıç ve takip değerleri dağılıma uygun olarak bağımsız örneklem t-testi veya Wilcoxon test ile değerlendirildi. Bulgular: Ortalama SV Tei indeksi 0.46±0.14 ve ortalama sistolik pulmoner arter basıncı (sPAP) 40±20 mmHg idi. Hastaların %37'sinde artmış cTn-T düzeyi saptandı (normal değer 0.01< ng/mL). SV Tei indeksi, sPAP ve cTn-T düzeyi arasında anlamlı korelasyon gözlendi (r=0.467 ve r=0.468, p<0.001,

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“…[11][12][13][14] Some PE patients have initially negative troponin test results but may show a release of troponin 6 to 12 hours later. 10,11,13 Myocardial ischemia and micro-infarction due to alterations in oxygen supply and demand of the failing right ventricle probably play a major role in the pathogenesis of troponin release (Figure 1). Release of troponin can occur in patients with PE in the absence of angiographic coronary artery disease.…”

Section: Pathophysiology Of Cardiac Biomarker Elevation In Pulmonary mentioning

confidence: 99%

Cardiac Biomarkers for Risk Stratification of Patients With Acute Pulmonary Embolism

2003

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Cardiac Troponin T Monitoring Identifies High-Risk Group of Normotensive Patients With Acute Pulmonary Embolisma

Cited by 202 publications

References 18 publications

Myocardial injury or infarction associated with fat embolism in sickle cell disease: A report of three cases with survival

Myocardial injury or infarction associated with fat embolism in sickle cell disease: A report of three cases with survival

Relationship between cardiac troponin-T and right ventricular Tei index in patients with hemodynamically stable pulmonary embolism: an observational study

Cardiac Biomarkers for Risk Stratification of Patients With Acute Pulmonary Embolism

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