Value of cardiac biomarkers in patients with acute pulmonary embolism

ABSTRACT

Prognostic stratification of patients with PE is important in management and potentially improve clinical outcome. Cardiac biomarkers are used as an adjunct to clinical and echocardiographic risk stratification in a variety of circumstances, [Creatine-kinase-MB [CK-MB]] and cardiac troponin I [cTnl] are most widely used because of their high sensitivities, and very high specificity of troponin for heart muscle injury. Evidence is mounting that myoglobin's sensitivity for myocardial necrosis combined with its unique release and clearance properties may render it particularly attractive as a risk marker either alone or in combination with other markers. The aim of the current study is to assess the levels of cardiac specific biomarkers in relation to different clinical, ECG and echocardiogrphic findings in patients with acute PE, as well as evaluating the prognostic value of these biomarkers for inhospital mortality and adverse clinical events. This study comprised 40 patients with proved PE [22 males and 18 females], their mean age was 50.05 +/- 13.09 years [range 22-70 years]. The following investigations were performed for all patients; 12-leads ECG, Full echo Doppler study, spiral CT of the chest, and laboratory testing arterial blood gas, serum myoglobin, serum troponin, total CK and CK-MB, kidney and liver function tests. Significant elevation of CK-MB [> 10 micro/L] was noted only in 7.5% of patients, while cardiac cTnl was elevated [>/= 0.07 ng/ml] in 45% of patients and elevated serum myoglobin was found very early after symptoms [<4 h] in 55% of patients. Elevated serum cTnl and myoglobin were significantly associated with ECG signs of right ventricular strain and echocardiographic evidence of right ventricular dysfunction. The results of the present study demonstrate the prognostic value of cardiac specific biomarkers, cardiac troponin I and myoglobin in acute pulmonary embolism. Thus, the current data combined with the results of previous studies strongly support the integration of troponin and myoglobin testing into the risk stratification and management of patients with established acute PE