The effect of troponin values on prognosis in acute pulmonary embolism

Authors

  • Gulay Dasdemir Ilkhan Department of Chest Diseases, Tire Public Hospital, Izmir, Turkey http://orcid.org/0000-0001-6453-3867
  • Hakan Celikhisar Esrefpasa Metropolitan Municipality Hospital, Izmir, Turkey

DOI:

https://doi.org/10.18203/2349-3259.ijct20204479

Keywords:

Pulmonary embolism, Prognosis, Troponin

Abstract

Background: The objective of this study is to evaluate the clinical usefulness of cardiac troponin levels in acute pulmonary thromboembolism (PTE) prognosis.

Methods: Thorax computed tomography (CT) angiography was performed and reported by the radiologist as pulmonary embolism and 193 patients older than 18 years of age who were considered PTE by the physician of chest diseases were included in the study. Patients diagnosed with PTE were divided into two groups as those who died within 30 days and did not die within 30 days. As a result of the statistically significant relationship between troponin and mortality, receiver operating characteristic (ROC) analysis was performed to determine the prognosis level of troponin and appropriate sensitivity and specificity cut-off values were determined.

Results: We determined that troponin levels of patients diagnosed with PTE in the emergency department were statistically significantly higher in the group with mortality (p=0.031). Since the area under the curve (AUC) value was calculated as 0.636, troponin value was found to have a weak-medium significance in terms of predicting 30-day mortality.

Conclusions: Troponin values are statistically significantly higher in patients with a one-month period than the survivor group in this period. However, we concluded that troponin values are not clinically usable as mortality markers due to their low sensitivity and specificity rates. However, due to its significant relationship with increased mortality, patients with PTE with high troponin values should be hospitalized and monitored closely.

Author Biography

Gulay Dasdemir Ilkhan, Department of Chest Diseases, Tire Public Hospital, Izmir, Turkey

Göğüs Hastalıkları Anabilim Dalı

References

Bennett A, Chunilal S. Diagnosis and Management of Deep Vein Thrombosis and Pulmonary Embolism in Pregnancy. Semin Thromb Hemost. 2016;42(7):760-73.

Widimský J. Diagnosis and treatment of acute pulmonary embolism in 2010. Vnitr Lek. 2011;57(1):5-21.

Bolt L, Lauber S, Limacher A, Samim D, Lowe A, Tritschler T, et al. Prognostic Value of Electrocardiography in Elderly Patients with Acute Pulmonary Embolism. Am J Med. 2019;132(12):835-43.

Carpenter SL, Richardson T, Hall M. Increasing rate of pulmonary embolism diagnosed in hospitalized children in the United States from 2001 to 2014. Blood Adv. 2018;2(12):1403-8.

Konstantinides SV, Torbicki A, Agnelli G, Danchin N, Fitzmaurice D, Galiè N, et al. 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J. 2014;35(43):3033-69.

Stuck AK, Spirk D, Schaudt J, Kucher N. Risk assessment models for venous thromboembolism in acutely ill medical patients. A systematic review. Thromb Haemost. 2017;117(4):801-8.

Lee CH, Cheng CL, Lin LJ, Tsai LM, Yang YH. Epidemiology and predictors of short-term mortality in sympromatic venous thromboembolism-A nationwide population based study. Circ J. 2011;75:1998-2004.

Dahhan T, Siddiqui I, Tapson VF, Velazquez EJ, Sun S, Davenport CA, Samad Z, Rajagopal S. Clinical and echocardiographic predictors of mortality in acute pulmonary embolism. Cardiovasc Ultrasound. 2016;14(1):44.

Bajaj A, Rathor P, Sehgal V, Kabak B, Shetty A, Al Masalmeh O, Hosur S. Prognostic Value of Biomarkers in Acute Non-massive Pulmonary Embolism: A Systematic Review and Meta-analysis. Lung. 2015;193(5):639-51.

Xiao W, Cao R, Liu Y, Wang F, Bai Y, Wu H, et al. Association of high-sensitivity cardiac troponin T with mortality and cardiovascular events in a community-based prospective study in Beijing. BMJ Open. 2017;7(6):013431.

Secemsky E, Chang Y, Jain CC, Beckman JA, Giri J, Jaff MR, et al. Contemporary Management and Outcomes of Patients with Massive and Submassive Pulmonary Embolism. Am J Med. 2018;131(12):1506-14.

Hepburn-Brown M, Darvall J, Hammerschlag G. Acute pulmonary embolism: a concise review of diagnosis and management. Intern Med J. 2019;49(1):15-27.

Chaudhury P, Gadre SK, Schneider E, Renapurkar RD, Gomes M, Haddadin I, et al. Impact of Multidisciplinary Pulmonary Embolism Response Team Availability on Management and Outcomes. Am J Cardiol. 2019;124(9):1465-9.

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.

Wang H, Xu X, Pu C, Li L. Clinical characteristics and prognosis of cancer patients with venous thromboembolism. J Cancer Res Ther. 2019;15(2):344-9.

Di Nisio M, van Es N, Büller HR. Deep vein thrombosis and pulmonary embolism. Lancet. 2016;388(10063):3060-73.

The PIOPED investigators. Value of the ventilation/perfusion scan in acute pulmonary embolism. JAMA. 1990;263:2753-9.

Alcaraz AC, Martínez AL, Solano FJS. Diagnosing pulmonary embolisms: the clinician's point of view. Diagnóstico de la embolia pulmonar. El punto de vista del médico clínico. Radiologia. 2017;59(2):166-76.

Ghanima W, Abdelnoor M, Mowinckel MC, Sandset PM. The performance of STA-Lia test D-Dimer assay in out-patients with suspected pulmonary embolism. Br J Haematol. 2006;132:210-5.

Agarwal A, Persaud J, Grabinski R, Rabinowitz D, Bremner A, Mendelson R. Pulmonary embolism: are we there yet? J Med Imaging Radiat Oncol. 2012;56(3):270-81.

Kalkan AK, Ozturk D, Erturk M, Kalkan ME, Cakmak HA, Oner E, et al. The diagnostic value of serum copeptin levels in an acute pulmonary embolism. Cardiol J. 2016;23(1):42-50.

Abu Assab T, Raveh-Brawer D, Abramowitz J, Naamad M, Ganzel C. The Predictive Value of Thromboelastogram in the Evaluation of Patients with Suspected Acute Venous Thromboembolism. Acta Haematol. 2020;143(3):272-8.

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.

Martinez JLA, Sánchez FJA, Echezarreta MAU, García IV, Álvaro JR. Central Versus Peripheral Pulmonary Embolism: Analysis of the Impact on the Physiological Parameters and Long-term Survival. N Am J Med Sci. 2016;8(3):134-42.

Konstam MA, Kiernan MS, Bernstein D, Bozkurt B, Jacob M, Kapur NK, et al. Evaluation and Management of Right-Sided Heart Failure: A Scientific Statement From the American Heart Association. Circulation. 2018;137(20):578-622.

Campbell AR, Rodriguez AJ, Larson DM, Strauss CE, Garberich RF, Partridge MF, Henry TD, Sharkey SW. Resource utilization and outcome among patients with selective versus nonselective troponin testing. Am Heart J. 2018;199:68-74.

Keller K, Geyer M, Beule J, Coldewey M, Balzer JO, Dippold W. Impact of cancer on the effectiveness of cardiac Troponin I to predict right ventricular dysfunction in acute pulmonary embolism. Thorac Cancer. 2015;6(5):584-8.

Jiménez D, Díaz G, Molina J, Martí D, Del Rey J, García-Rull S, et al. Troponin I and risk stratification of patients with acute non massive pulmonary embolism. Eur Respir J. 2008;31:847-53.

Kucher N, Wallmann D, Carone A, Windecker S, Meier B, Hess OM. Incremental prognostic value of troponin I and echocardiography in patients with acute pulmonary embolism. Eur Heart J. 2003;24:1651-6.

Giannitsis E, Müller-Bardorff M, Kurowski V, Weidtmann B, Wiegand U, Kampmann M, et al. Independent prognostic value of cardiac troponin T in patientwitk confirmed pulmonary embolism. Circulation. 2000;102:211-7.

Tanabe Y, Obayashi T, Yamamoto T, Takayama M, Nagao K. Predictive value of biomarkers for the prognosis of acute pulmonary embolism in Japanese patients: Results of the Tokyo CCU Network registry. J Cardiol. 2015;66(6):460-5.

Jiménez D, Aujesky D, Moores L, Gómez V, Martí D, Briongos S, et al. Combinations of prognostic tools for identification of high-risk normotensive patients with acute symptomatic pulmonary embolism. Thorax. 2011;66:75-81.

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Published

2020-10-20

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Original Research Articles