Value of transthoracic echocardiography combined with cardiac troponin I in risk stratification in acute pulmonary thromboembolism / 中华医学杂志(英文版)
Chinese Medical Journal
;
(24): 17-21, 2007.
Artículo
en Inglés
| WPRIM
| ID: wpr-273345
ABSTRACT
<p><b>BACKGROUND</b>Acute pulmonary thromboembolism (APE) causes right ventricular dysfunction (RVD) and cardiac troponin I (cTnI) elevation. Patients with RVD and cTnI elevation have a worse prognosis. Thus, early detection of RVD and cTnI elevation is beneficial for risk stratification. In this study, we assessed 14-day adverse clinical events and combined RVD on transthoracic echocardiography (TTE) with cTnI in risk stratification among a broad spectrum of APE patients.</p><p><b>METHODS</b>The prospective multi-centre trial included 90 patients with confirmed APE from 12 collaborating hospitals. Acute RVD on TTE was diagnosed in the presence of at least 2 of the following right ventricular dilatation (without hypertrophy), loss of inspiratory collapse of inferior vena cava (IVC), right ventricular (RV) hypokinesis, tricuspid regurgitant jet velocity > 2.8 m/s. The study patients were divided into two groups according to clinical and echocardiographic findings at presentation Group I 50 patients with RVD; Group II 40 patients without RVD.</p><p><b>RESULTS</b>More than half of the patients (50/90, 55.6%) had RVD. Nearly one third (26/90, 28.9%) of patients had elevated cTnI at presentation and only 4.2% on the fourth day after initial therapy. A multiple Logistic regression model implied RVD, right and left ventricular end-diastolic diameter ratio (RVED/LVED), and cTnI independently predict an adverse 14-day clinical outcome (P < 0.01). Receiver operating characteristics (ROC) curves revealed that the cut-off values of RVED/LVED and cTnI yielding the highest discriminating power were 0.65 and 0.11 ng/ml, respectively. Furthermore, the incidence of an adverse 14-day clinical event in patients with RVD and elevated cTnI was greater (40.7%) than in patients with elevated cTnI or positive RVD alone (0% and 8.3%, respectively) (P < 0.001).</p><p><b>CONCLUSIONS</b>RVD, RVED/LVED, and cTnI are independent predictors of 14-day clinical outcomes. The patients with RVED/LVED greater than 0.65 and cTnI higher than 0.11 ng/ml at presentation possibly have adverse 14-day events. RVD combined with cTnI can identify a subgroup of APE patients with a much more guarded prognosis.</p>
Texto completo:
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Índice:
WPRIM (Pacífico Occidental)
Asunto principal:
Pronóstico
/
Embolia Pulmonar
/
Sangre
/
Diagnóstico por Imagen
/
Ecocardiografía
/
Enfermedad Aguda
/
Disfunción Ventricular Derecha
/
Troponina I
/
Diagnóstico
Tipo de estudio:
Estudio diagnóstico
/
Estudio de etiología
/
Estudio pronóstico
/
Estudio de tamizaje
Límite:
Adulto
/
Anciano
/
Femenino
/
Humanos
/
Masculino
Idioma:
Inglés
Revista:
Chinese Medical Journal
Año:
2007
Tipo del documento:
Artículo
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