Margato Renato, Carvalho Sofia, Ribeiro Hélder, Mateus Pedro, Fontes Paulo, Moreira J Ilídio
Serviço de Cardiologia, Centro Hospitalar de Trás-os-Montes-e-Alto-Douro, Vila Real, Portugal.
Rev Port Cardiol. 2009 Nov;28(11):1213-22.
Estimation of individual risk and choice of initial therapeutic approach for patients with pulmonary embolism (PE) remains controversial. The three key components for risk stratification in PE are clinical evaluation, cardiac biomarkers and assessment of right ventricular size and function. The aim of this study was to assess the ability of admission troponin I (TnI) levels to predict short-term mortality and complicated clinical course in patients with PE.
We performed a retrospective analysis of 100 consecutive patients admitted with a diagnosis of PE between January 2004 and November 2007. Patients in whom the diagnosis was confirmed by spiral computed tomography, ventilation perfusion scan, pulmonary angiography or echocardiography and with serum TnI measurement in the first 24 hours of hospital stay were selected. The study population (n = 62) was divided into two groups according to the presence or absence of elevated TnI levels (TnI > or = 0.10 ng/ml). Clinical characteristics, electrocardiographic and echocardiographic signs of right ventricular dysfunction (RVD), brain natriuretic peptide (BNP) levels, in-hospital mortality and the composite endpoint of complicated PE (defined as the presence of at least one of the following: in-hospital death, cardiogenic shock, need for mechanical ventilation or inotropic support) were compared between groups.
Thirty-seven patients (59.7%) had elevated TnI levels (Tpos) and 25 (40.3%) had normal levels (Tneg). The two groups were not significantly different (p = NS) in age (66.2 vs. 71 years), gender (female 70.3 vs. 60.0%), clinical presentation or length of hospital stay (14.7 vs. 18.1 days). Tpos patients had a higher prevalence of electrocardiographic signs of RVD (78.4 vs. 40.0%, p < 0.01). Echocardiographic RVD was also more common in the Tpos group but the difference did not reach statistical significance (56.0% vs. 27.3%, p = NS). Elevated serum TnI was significantly associated with complicated in-hospital clinical course (complicated PE: 29.7% in the Tpos group vs. 4.0% in the Tneg group (adjusted OR = 9.08; 95% CI 1.07-77.4; p = 0.044). In-hospital mortality was 8.1%, with a strong trend for higher mortality in the Tpos group (13.5% vs. 0%, p = 0.055).
Elevated TnI levels are associated with higher risk for in-hospital mortality and complicated clinical course. Additional studies are needed to assess whether troponin levels, alone or in conjunction with other tests, can be used to guide therapeutic strategy and improve the prognosis of patients with PE.
肺栓塞（PE）患者个体风险评估及初始治疗方法的选择仍存在争议。PE风险分层的三个关键要素是临床评估、心脏生物标志物以及右心室大小和功能评估。本研究旨在评估入院时肌钙蛋白I（TnI）水平预测PE患者短期死亡率及复杂临床病程的能力。
我们对2004年1月至2007年11月期间连续收治的100例诊断为PE的患者进行了回顾性分析。选择经螺旋计算机断层扫描、通气灌注扫描、肺血管造影或超声心动图确诊且在住院的前24小时内进行了血清TnI检测的患者。研究人群（n = 62）根据TnI水平是否升高（TnI>或= 0.10 ng/ml）分为两组。比较两组的临床特征、右心室功能不全（RVD）的心电图和超声心动图表现、脑钠肽（BNP）水平、住院死亡率以及复杂PE（定义为存在以下至少一项：住院死亡、心源性休克、需要机械通气或使用血管活性药物支持）的复合终点。
37例患者（59.7%）TnI水平升高（Tpos组），25例（40.3%）水平正常（Tneg组）。两组在年龄（66.2岁对71岁）、性别（女性70.3%对60.0%）、临床表现或住院时间（14.7天对18.1天）方面无显著差异（p = NS）。Tpos组患者RVD的心电图表现更为常见（78.4%对40.
