Department of Internal Medicine and Research and Advanced Studies Program, Michigan State University, East Lansing, MI, USA.
Am J Cardiol. 2011 Mar 1;107(5):774-7. doi: 10.1016/j.amjcard.2010.10.061. Epub 2011 Jan 19.
Prognosis of stable patients with acute pulmonary embolism (PE) has been assessed with cardiac troponin I (cTnI) and right ventricular (RV) function or size. Whether creatine kinase-MB isoenzyme (CK-MB) would add to the prognostic assessment is uncertain. We retrospectively assessed in-hospital mortality from PE in 392 stable patients to test the hypothesis that CK-MB would be of greater prognostic value than cTnI or RV size and we assessed whether combinations would increase prognostic value. CK-MB was high in 29 patients (7.4%); cTnI was high in 76 patients (19%) and intermediate in 78 patients (20%). The right ventricle was dilated in 128 patients (33%). Trends showed highest in-hospital mortality from PE in 4 of 29 (14%) with high CK-MB compared to 6 of 76 (7.9%) with high cTnI and 8 of 128 (6.3%) with RV dilatation (differences NS). High CK-MB and high cTnI provided added prognostic information only in patients with RV dilatation. Mortality with high CK-MB plus RV dilatation (4 of 19, 21%) tended to exceed mortality with high cTnI plus RV dilatation (5 of 39, 13%, NS). When CK-MB and cTnI were high and the right ventricle was dilated, PE mortality tended to be highest (4 of 14, 29%, NS). In conclusion, cardiac biomarkers contributed to prognosis only in patients with RV dilatation. CK-MB was the strongest predictor of death from PE but its prevalence was low, thus limiting its value as a single prognostic indicator. The combination of high CK-MB, high cTnI, and RV dilatation tended to indicate the highest mortality.
急性肺栓塞（PE）稳定患者的预后已通过心脏肌钙蛋白 I（cTnI）和右心室（RV）功能或大小进行评估。肌酸激酶同工酶 MB （CK-MB）是否会增加预后评估尚不确定。我们回顾性评估了 392 例稳定型 PE 患者的院内死亡率，以检验 CK-MB 的预后价值是否高于 cTnI 或 RV 大小的假设，并评估了组合是否会增加预后价值。29 例患者（7.4%）CK-MB 升高；76 例患者（19%）cTnI 升高，78 例患者（20%）cTnI 中度升高。128 例患者（33%）RV 扩张。趋势显示，与 cTnI 高（76 例中的 6 例，7.9%）和 RV 扩张（128 例中的 8 例，6.3%）相比，CK-MB 高（29 例中的 4 例，14%）的患者 PE 院内死亡率最高（差异无统计学意义）。CK-MB 和 cTnI 高仅为 RV 扩张患者提供了额外的预后信息。CK-MB 高加 RV 扩张（19 例中的 4 例，21%）的死亡率倾向于高于 cTnI 高加 RV 扩张（39 例中的 5 例，13%，差异无统计学意义）。当 CK-MB 和 cTnI 高且 RV 扩张时，PE 死亡率倾向于最高（14 例中的 4 例，29%，差异无统计学意义）。总之，心脏生物标志物仅在 RV 扩张的患者中对预后有贡献。CK-MB 是 PE 死亡的最强预测指标，但阳性率较低，因此限制了其作为单一预后指标的价值。CK-MB、cTnI 高和 RV 扩张的组合往往预示着最高的死亡率。
