Ng PL, Kwok CH, Tsui SH, Tong HK
Correspondence: Dr Pui-Lok Ng, lucypl@yahoo.com
ABSTRACT
Introduction Acute pulmonary embolism (PE) is an uncommon but potentially fatal disease. Acute right ventricular failure, which can be demonstrated by echocardiography, is known to be an adverse prognostic factor in patients with acute PE. However, this diagnostic test is not always available in emergency departments and it is also an operator-dependent investigation. This study aimed to investigate whether cardiac troponin I (cTnI) levels could predict clinical outcomes in Chinese patients with PE.
Methods This was a retrospective cohort study performed in a tertiary regional hospital in Hong Kong. For this study, 100 patients who were diagnosed with acute PE between January 1, 2002 and December 31, 2009 were recruited. Information, including demographic data, presenting symptoms and vital signs at presentation, predisposing factors for PE, results of diagnostic procedures and clinical outcomes, was collected from the medical records of these patients.
Results 71% of recruited patients had elevated cTnI levels. High cTnI levels were associated with haemodynamic instability (odds ratio [OR] 5.30, 95% confidence interval [CI] 1.32–27.71; p = 0.019) and complicated clinical course (OR 6.34, 95% CI 1.76–22.9; p = 0.002).
Conclusion Elevated cTnI level was associated with a complicated clinical course in patients with acute PE. We suggest that measurements of cTnI levels be used for the early risk stratification of patients with PE in the emergency departments of hospitals.
Keywords: cTnI, Chinese, PE, pulmonary embolism, troponin I
Singapore Med J 2013; 54(2): 86–89; http://dx.doi.org/10.11622/smedj.2013030
REFERENCES
1. Goldhaber SZ, Visani L, De Rosa M. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet 1999; 353:1386-9. http://dx.doi.org/10.1016/S0140-6736(98)07534-5 | ||||
2. Kasper W, Konstantinides S, Geibel A, et al. Prognostic significance of right ventricular afterload stress detected by echocardiography in patients with clinically suspected pulmonary embolism. Heart 1997; 77:346-9. | ||||
3. Alpert JS, Thygesen K, Antman E, Bassand JP. Myocardial infarction redefined--a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction. J Am Coll Cardiol 2000; 36:959-69. http://dx.doi.org/10.1016/S0735-1097(00)00804-4 | ||||
4. Kucher N, Wallmann D, Carone A, et al. Incremental prognostic value of troponin I and echocardiography in patients with acute pulmonary embolism. Eur Heart J 2003; 24:1651-6. http://dx.doi.org/10.1016/S0195-668X(03)00394-4 | ||||
5. Mehta NJ, Jani K, Khan IA. Clinical usefulness and prognostic value of elevated cardiac troponin I levels in acute pulmonary embolism. Am Heart J 2003; 145:821-5. http://dx.doi.org/10.1016/S0002-8703(02)94704-6 | ||||
6. Konstantinides S, Geibel A, Olschewski M, et al. Importance of cardiac troponins I and T in risk stratification of patients with acute pulmonary embolism. Circulation 2002; 106:1263-8. http://dx.doi.org/10.1161/01.CIR.0000028422.51668.A2 | ||||
7. Silverstein MD, Heit JA, Mohr DN, et al. Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. Arch Intern Med 1998; 158:585-93. http://dx.doi.org/10.1001/archinte.158.6.585 | ||||
8. Liu HS, Kho BC, Chan JC, et al. Venous thromboembolism in the Chinese population--experience in a regional hospital in Hong Kong. Hong Kong Med J 2002; 8:400-5. | ||||
9. Chan LC, Bourke C, Lam CK, et al. Lack of activated protein C resistance in healthy Hong Kong Chinese blood donors-correlation with absence of Arg506-Gln mutation of factor V gene. Thromb Haemost 1996; 75:522-3. PMid:8701422 | ||||
10. Aksay E, Yanturali S, Kiyan S. Can elevated troponin I levels predict complicated clinical course and inhospital mortality in patients with acute pulmonary embolism? Am J Emerg Med 2007; 25:138-43. http://dx.doi.org/10.1016/j.ajem.2006.06.005 | ||||
11. Kasper W, Konstantinides S, Geibel A, et al. Management strategies and determinants of outcome in acute major pulmonary embolism: results of a multicenter registry. J Am Coll Cardiol 1997; 30:1165-71. http://dx.doi.org/10.1016/S0735-1097(97)00319-7 | ||||
12. Torbicki A, Perrier A, Konstantinides S, et al. Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur Heart J 2008; 29:2276-315. http://dx.doi.org/10.1093/eurheartj/ehn310 | ||||
13. Goldhaber SZ. Pulmonary embolism. Lancet 2004; 363:1295-305. http://dx.doi.org/10.1016/S0140-6736(04)16004-2 | ||||
14. Meyer T, Binder L, Hruska N, Luthe H, Buchwald AB. Cardiac troponin I elevation in acute pulmonary embolism is associated with right ventricular dysfunction. J Am Coll Cardiol 2000; 36:1632-6. http://dx.doi.org/10.1016/S0735-1097(00)00905-0 | ||||
15. Giannitsis E, Müller-Bardorff M, Kurowski V, et al. Independent prognostic value of cardiac troponin T in patients with confirmed pulmonary embolism. Circulation 2000; 102:211-7. http://dx.doi.org/10.1161/01.CIR.102.2.211 | ||||
16. Becattini C, Vedovati MC, Agnelli G. Prognostic value of troponins in acute pulmonary embolism: a meta-analysis. Circulation 2007; 116:427-33. http://dx.doi.org/10.1161/CIRCULATIONAHA.106.680421 | ||||
17. Punukollu G, Khan IA, Gowda RM, et al. Cardiac troponin I release in acute pulmonary embolism in relation to the duration of symptoms. Int J Cardiol 2005; 99:207-11. http://dx.doi.org/10.1016/j.ijcard.2004.01.012 | ||||
18. Pruszczyk P, Bochowicz A, Torbicki A, et al. Cardiac troponin T monitoring identifies high-risk group of normotensive patients with acute pulmonary embolism. Chest 2003; 123:1947-52 http://dx.doi.org/10.1378/chest.123.6.1947 | ||||
19. Müller-Bardorff M, Weidtmann B, Giannitsis E, Kurowski V, Katus HA. Release kinetics of cardiac troponin T in survivors of confirmed severe pulmonary embolism. Clin Chem 2002; 48:673-5. |