Prognostic Value of Biomarkers in Acute Non-massive Pulmonary Embolism: A Systematic Review and Meta-analysis

Bajaj, Archna; Rathor, Parul; Sehgal, Vasudha; Kabak, Besher; Shetty, Ajay; Masalmeh, Ossama Al; Hosur, Srikanth

doi:10.1007/s00408-015-9752-4

Cited by 49 publications

(29 citation statements)

References 51 publications

(43 reference statements)

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“…This has been shown for patients with heart failure, 1 renal failure, 2 gastrointestinal bleeding, 3 sepsis, 4 respiratory disease, 5 pulmonary embolism, 6 subarachnoid hemorrhagic, or stroke. 7,8 An elevated troponin level even indicates a worse prognosis in asymptomatic people without known cardiovascular disease.…”

Section: Introductionmentioning

confidence: 93%

Managing Troponin Testing

Hollander

2016

Annals of Emergency Medicine

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Section: Introductionmentioning

confidence: 93%

Managing Troponin Testing

Hollander

2016

Annals of Emergency Medicine

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“…Increased cardiac troponin in PE reflects the degree of RV overload and dysfunction, which is the critical determinant of outcome. Accordingly, increased cardiac troponin has been shown to be a strong predictor of all-cause mortality with an OR of 5.2 (95% CI 3.3-8.4) for conventional assays (79 ) and of 7.9 (95% 2.9 -21.0) for the hs-cTnT assay (81 ). For an in-depth analysis of the implications of cardiac troponin regarding the management of patients with PE, we refer interested readers to the review by Giannitsis and Katus (82 ) in this issue of Clinical Chemistry.…”

Section: Pulmonary Arterial Hypertensionmentioning

confidence: 99%

Application of Cardiac Troponin in Cardiovascular Diseases Other Than Acute Coronary Syndrome

Eggers¹,

Lindahl

2017

Clinical Chemistry

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BACKGROUND Increased cardiac troponin concentrations in acute coronary syndrome (ACS) identify patients with ongoing cardiomyocyte necrosis who are at increased risk. However, with the use of more precise assays, cardiac troponin increases are commonly noted in other cardiovascular conditions as well. This has generated interest in the use of cardiac troponin for prognostic assessment and clinical management of these patients. In this review, we have summarized the data from studies investigating the implications of cardiac troponin concentrations in various acute and chronic conditions beyond ACS, i.e., heart failure, myocarditis, Takotsubo cardiomyopathy, aortic dissection, supraventricular arrhythmias, valve disease, pulmonary arterial hypertension, stroke, and in the perioperative setting. CONTENT Cardiac troponin concentrations are often detectable and frankly increased in non-ACS conditions, in particular when measured with high-sensitivity (hs) assays. With the exception of myocarditis and Takotsubo cardiomyopathy, cardiac troponin concentrations carry strong prognostic information, mainly with respect to mortality, or incipient and/or worsening heart failure. Studies investigating the prognostic benefit associated with cardiac troponin–guided treatments however, are almost lacking and the potential role of cardiac troponin in the management of non-ACS conditions is not defined. SUMMARY Increased cardiac troponin indicates increased risk for adverse outcome in patients with various cardiovascular conditions beyond ACS. Routine measurement of cardiac troponin concentrations can however, not be generally recommended unless there is a suspicion of ACS. Nonetheless, any finding of an increased cardiac troponin concentration in a patient without ACS should at least prompt the search for possible underlying conditions and these should be managed meticulously according to current guidelines to improve outcome.

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“…29 Conversely, normal BNP levels (< 100 ng/L) practically ruled out PTE in patients at low clinical risk (PESI = 0). 23 False positive results can occur in situations with neurohumoral stimulation, inflammation, and ischemia.…”

Section: C) Computed Tomography (Ct): This Is a Very Usefulmentioning

confidence: 99%

“…Patients with three or more points are considered high risk. 29 There are algorithms that combine clinical markers with laboratory and imaging findings, but it is not yet clear which combination is ideal for identifying intermediate risk PTE patients who have poor prognosis.…”

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confidence: 99%

Terapia fibrinolítica sistêmica no tromboembolismo pulmonar

Ceresetto

Marques

2017

J. vasc. bras.

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Pulmonary thromboembolism remains a major therapeutic challenge for specialists and, despite investment and the consequent developments in diagnosis, prophylaxis, and treatment, the condition is still the leading cause of avoidable deaths in hospital settings. There is still great uncertainty with relation to the profile of patients who will actually benefit from systemic fibrinolytic treatment, without being exposed to serious risk of bleeding. There are tools that can help to identify patients who will benefit, including risk stratification and estimation of the prognosis of the event, with clinical scores for right ventricular failure, markers of right ventricular dysfunction and dilatation, and thrombotic mass assessment, whether alone or in combination. The only points of consensus with relation to fibrinolytic therapy for treatment of pulmonary thromboembolism are as follows: it should not be routinely indicated, none of the scores or markers alone should be used to justify its use, and patients with hemodynamic instability are the most likely to benefit. Furthermore, each case should be evaluated for risk of bleeding, especially central nervous system bleeding.Keywords: fibrinolytics; pulmonary embolism; hemorrhage. ResumoO tromboembolismo pulmonar permanece como um grande desafio terapêutico para os médicos especialistas, pois, apesar de todo investimento e desenvolvimento em seu diagnóstico, profilaxia e tratamento, essa condição continua sendo a principal causa de morte evitável em ambiente hospitalar. Ainda restam muitas dúvidas em relação a qual perfil de paciente vai se beneficiar de fato da terapia fibrinolítica sistêmica, sem ficar exposto a um grande risco de sangramento. A estratificação de risco e a avaliação do prognóstico do evento, através de escores clínicos de insuficiência ventricular direita, marcadores de dilatação e disfunção do ventrículo direito e avaliação da massa trombótica, associados ou de forma isolada, são ferramentas que podem auxiliar na identificação do paciente que irá se beneficiar dessa terapia. Os únicos consensos em relação à terapia fibrinolítica no tratamento do tromboembolismo pulmonar são: não deve ser indicada de forma rotineira; nenhum dos escores ou marcadores, isoladamente, devem justificar seu uso; e os pacientes com instabilidade hemodinâmica são os mais beneficiados. Além disto, deve-se avaliar cada caso em relação ao risco de sangramento, especialmente no sistema nervoso central.Palavras-chave: fibrinolíticos; embolia pulmonar; hemorragia.

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Prognostic Value of Biomarkers in Acute Non-massive Pulmonary Embolism: A Systematic Review and Meta-analysis

Abstract: None of the biomarker identifies a subgroup of patients who can be managed as an outpatient versus patients who may get benefit from thrombolytics with certainty; however, H-FABP and hs-cTnT showed some promising results and should be investigated further.

Cited by 49 publications

References 51 publications

Managing Troponin Testing

Managing Troponin Testing

Application of Cardiac Troponin in Cardiovascular Diseases Other Than Acute Coronary Syndrome

Terapia fibrinolítica sistêmica no tromboembolismo pulmonar

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