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

Abstract

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,

Pulmoner Embolide Şiddet ve Prognozun Değerlendirilmesi

“…Ne yazık ki, yapılan çalışmalarda sağ ventrikül (RV) dilatasyonu, hipokinezisi, artmış RV/sol ventrikül (LV) çap oranı, interventriküler septumda paradoksal hareket, trikuspit regurjitasyonu jet akım hızında artış, RV miyokardiyal ferformans indeksi gibi RVD ait farklı EKO bulguları kullanılmıştır 31,32,33,34 . Bu nedenle, EKO'da RVD'nin herkes tarafından kabul görmüş bir tanımı bulunmamaktadır.…”

“…Benzer şekilde, Jimenez ve ark'ları, yaptıkları metaanalizde, artmış cTn'lerin tüm nedenlere bağlı ölüm riskini 4.26 kat arttırdığını tespit ettiler 60 . Ayrıca, artmış cTn'lerle PAOI ve RVD arasında yakın bir ilişki olduğu gösterilmiştir 33,48,57 . Bu arada, cTnI ile T'nin etkinliği arasında fark gösterilememiştir.…”

Right ventricular functions in pulmonary embolism

“…While these two studies did not investigate the relationship between the RV Tei index and cTn-T, the current study examined this relationship. Positive correlations were found between cTn-T levels and RV Tei index (r=0.467, p<0.003) (10).…”

“…In the article published in the current issue of the Anatolian Journal of Cardiology, Özsu et al (10) carried out a study on the relationship between the RV Tei index and cTn-T in patients with acute normotensive PE. The results of this study showed that RV Tei index has been frequently impaired in patients with acute PE and a significant recovery has been seen after the treatment.…”

Creatinine kinase isoenzyme–MB: A simple prognostic biomarker in patients with pulmonary embolism treated with thrombolytic therapy

“…RV dysfunction, an important predictor of mortality in PE cases, may be determined by imaging methods (computed tomography [CT], echocardiography) or laboratory markers such as brain natriuretic peptide (BNP), N-terminal (NT)-pro BNP, cardiac troponin I (cTnI) or T (cTnT), and heart-type fatty acid-binding protein (h-FABP) [1,[7][8][9][10][11][12]. Creatinine kinase isoenzyme MB (CK-MB) is an important biomarker for detecting myocardial injury [13].…”