Combined utility of brain natriuretic peptide and cardiac troponine T may improve rapid triage and risk stratification in normotensive patients with pulmonary embolism

Tulevski, Igor I.; Wolde, M. Ten; Veldhuisen, Dirk J. van; Mulder, Jasper W.M.; Wall, Ernst E. van der; Büller, Harry R.; Mulder, Barbara J.M.

doi:10.1016/j.ijcard.2006.03.030

Cited by 59 publications

(44 citation statements)

References 20 publications

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“…First, the fact that elevated TNT is an independent predictor of short-term mortality in PE, as previously suggested by several small studies [8,[11][12][13][14][15][16][17], is confirmed in our cohort study. By including the results for in-hospital mortality from the metaanalysis of BECATTINI et al [7], our study adds a lot of information on the presumed true predictive value of TNT ( fig.…”

Section: Discussionsupporting

confidence: 89%

Troponin T predicts in-hospital and 1-year mortality in patients with pulmonary embolism

Janata

Leitner²,

Holzer-Richling³

et al. 2009

European Respiratory Journal

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We aimed to determine the prognostic value of troponin T (TNT) for in-hospital and 1-yr mortality in a large sample of patients with pulmonary embolism (PE).Patients presenting at the emergency department of a tertiary care centre from January 1998 to December 2006 with PE were included. A blood sample was taken at the time of presentation. To determine in-hospital and 1-yr mortality, data from the hospital records and the national death register were used.TNT was determined in 563 out of 737 patients with proven PE. TNT was elevated (.0.03ng?mL -1 ) in 27%. In-hospital survival was 79% in TNT-positive patients compared with 94% in TNT-negative patients (p,0.001). 1-yr survival was 71% in TNT-positive patients compared with 90% in TNT-negative patients (p,0.001). Elevated TNT levels meant a four-times higher risk of in-hospital death and a three-times higher risk of 1-yr mortality, even after adjustment for the other most important risk factors of death in this population.Elevated TNT independently predicts in-hospital and 1-yr mortality in patients with acute PE.

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Section: Discussionsupporting

confidence: 89%

Troponin T predicts in-hospital and 1-year mortality in patients with pulmonary embolism

Janata

Leitner²,

Holzer-Richling³

et al. 2009

European Respiratory Journal

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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: 46%

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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“…22,23 Becattini et al 24 reported that elevation of troponin I and/or T was associated with higher mortality (17.9%) compared to patients with normal troponin levels (2.3%), even in a subgroup of hemodynamically stable patients. Our study also confirmed that elevated troponin T was associated with higher mortality in non-high-risk patients ( Figure 2).…”

Section: Discussionmentioning

confidence: 99%

Usefulness of Combined Assessment With Computed Tomographic Signs of Right Ventricular Dysfunction and Cardiac Troponin T for Risk Stratification of Acute Pulmonary Embolism

Kang¹,

Sun²,

Park³

et al. 2011

The American Journal of Cardiology

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Combined utility of brain natriuretic peptide and cardiac troponine T may improve rapid triage and risk stratification in normotensive patients with pulmonary embolism

Cited by 59 publications

References 20 publications

Troponin T predicts in-hospital and 1-year mortality in patients with pulmonary embolism

Troponin T predicts in-hospital and 1-year mortality in patients with pulmonary embolism

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

Usefulness of Combined Assessment With Computed Tomographic Signs of Right Ventricular Dysfunction and Cardiac Troponin T for Risk Stratification of Acute Pulmonary Embolism

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