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

      Study objectives

      Indications for thrombolysis in normotensive patients with pulmonary embolism (PE), based on the presence of right ventricular (RV) overload during transthoracic echocardiography (TTE), are controversial. We checked whether the monitoring of cardiac troponin T (cTnT) might help in risk stratification by detecting patients with RV myocardial injury.

      Patients and design

      We studied 64 normotensive patients (30 women and 34 men) with a mean (± SD) age of 61.3 ± 17 years and PE, who had undergone TTE for the assessment of RV overload. Plasma cTnT levels were measured quantitatively (detection limit, > 0.01 ng/mL) at hospital admission, and subsequently three times at 6-h intervals. Heparin therapy alone was used in 87.5% of patients, while 12.5% of patients received thrombolysis.

      Results

      cTnT was detected in 50% of patients. All eight in-hospital deaths occurred in the troponin-positive group, however, in one case the results of the first three assays had been negative. Elevated plasma cTnT increased the risk of PE-related death (odds ratio [OR], 21; 95% confidence interval [CI], 1.2 to 389). Increased age and elevated tricuspid regurgitant jet velocity, but not RV diameter/left ventricle diameter ratio, influenced the hospital mortality rate. Increased cTnT level was the only parameter predicting 15 in-hospital clinical adverse events (ie, death, thrombolysis, cardiopulmonary resuscitation, and IV use of catecholamine agents) [OR, 24.1; 95% CI, 2.9 to 200].

      Conclusions

      Patients with PE and elevated cTnT levels detected during repetitive assays are at a significant risk of a complicated clinical course and fatal outcome.

      Key words

      Abbreviations:

      APTT (activated partial thrombin time), CI (confidence interval), CK (creatine kinase), CKMB (MB isoenzyme of creatine kinase), cTnT (cardiac troponin T), IVC (inferior vena cava), LV (left ventricle, ventricular), OR (odds ratio), PE (pulmonary embolism), RV (right ventricle, ventricular), RV/LV (right ventricle diameter/left ventricle diameter ratio)
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      Linked Article

      • Cardiac Biomarkers in Pulmonary Embolism
        ChestVol. 123Issue 6
        • Preview
          Pulmonary embolism (PE) encompasses a wide spectrum of illnesses, with diverse prognoses and management strategies. Some PEs, detected serendipitously by chest CT scanning, cause no apparent adverse symptoms or signs. They are anatomically tiny and have minimal clinical impact, at least in patients without concomitant proximal leg deep vein thrombosis. The heparin treatment is required as a “bridge” to warfarin treatment. In this situation, the major debate is about whether to hospitalize the patients for the traditional 5 to 7 days, to abbreviate the hospital stay by using low-molecular-weight heparin in lieu of continuous IV infusion of unfractionated heparin, or even to consider complete outpatient therapy12with subsequent office follow-up.
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