Dursunoğlu Neşe, Dursunoğlu Dursun, Yıldız Ali İhsan, Rota Simin
Department of Chest, Faculty of Medicine, Pamukkale University, Denizli-Turkey.
Anatol J Cardiol. 2016 Apr;16(4):276-82. doi: 10.5152/akd.2014.5828. Epub 2014 Dec 31.
Right ventricular dysfunction (RVD) with myocardial damage may lead to fatal complications in patients with acute pulmonary embolism (PE). Cytoplasmic heart-type fatty acid-binding protein (HFABP) and the N-terminal fragment of its prohormone (NT-proBNP) are sensitive and specific biomarkers of myocardial damage. We evaluated RVD and cardiac biomarkers for myocardial damage and short-term mortality in patients with acute PE.
We analyzed 41 patients (24 females, 17 males) with confirmed acute PE prospective. Three groups (massive, submassive, and non-massive) of patients were defined, based on systemic systolic blood pressure measured on admission and RVD by transthoracic echocardiography (TTE). Also, systolic (s) and mean (m) pulmonary artery pressures (PAPs) were recorded by TTE, and plasma concentrations of cardiac troponin T (cTn-T), NT-proBNP, and HFABP were evaluated 6 month follow-up.
Seventeen (41.5%) patients experienced a complicated clinical course in the 6-month follow-up for the combined end-point, including at least one of the following: death (n=12, 29.3%; 3 PE-related), chronic PE (n=4, 9.8%), pulmonary hypertension (n=2, 4.9%), and recurrent PE (n=1, 2.4%). Multivariate hazard ratio analysis revealed HFABP, NT-proBNP, and PAPs as the 6-month mortality predictors (HR 1.02, 95% CI 1.01-1.05; HR 1.01, 95% CI 1.01-1.04; and HR 1.02, 95% CI 1.02-1.05, respectively).
HFABP, NT-proBNP, and PAPs measured on admission may be useful for short-term risk stratification and in the prediction of 6-month PE-related mortality in patients with acute PE.
右心室功能障碍（RVD）合并心肌损伤可能导致急性肺栓塞（PE）患者出现致命并发症。细胞质心脏型脂肪酸结合蛋白（HFABP）及其前体激素的N端片段（NT-proBNP）是心肌损伤敏感且特异的生物标志物。我们评估了急性PE患者的RVD及心肌损伤的心脏生物标志物和短期死亡率。
我们前瞻性分析了41例确诊为急性PE的患者（24例女性，17例男性）。根据入院时测量的全身收缩压和经胸超声心动图（TTE）检查的RVD情况，将患者分为三组（大面积、次大面积和非大面积）。此外，通过TTE记录收缩期（s）和平均（m）肺动脉压（PAP），并在6个月随访时评估血浆心肌肌钙蛋白T（cTn-T）、NT-proBNP和HFABP的浓度。
17例（41.5%）患者在6个月随访时出现了复合终点的复杂临床病程，包括以下至少一项：死亡（n = 12，29.3%；3例与PE相关）、慢性PE（n = 4，9.8%）、肺动脉高压（n = 2，4.9%）和复发性PE（n = 1，2.4%）。多因素风险比分析显示，HFABP、NT-proBNP和PAP是6个月死亡率的预测指标（HR分别为1.02，95%CI 1.01 - 1.05；HR 1.01，95%CI 1.01 - 1.04；HR 1.02，95%CI 1.02 - 1.05）。
入院时测量的HFABP、NT-proBNP和PAP可能有助于急性PE患者的短期风险分层以及预测6个月与PE相关的死亡率。
