Troponin-I in hemodynamically-stable pulmonary embolism: correlation with echocardiography and computed tomography angiography

Background: Troponin-I (TnI) is a marker of severe pulmonary thromboembolism (PTE) in unselected patients. There are few articles that assess its usefulness in hemodynamically-stable patients. Objectives: To assess the correlation between TnI levels and both echocardiographic/radiologic signs of right ventricle (RV) dysfunction or pulmonary hypertension (PH), and the severity of the pulmonary vascular obstruction. Methods: We selected patients from a prospective cohort of 103 consecutive patients with PTE and systolic arterial pressure >= 90 mmHg. Computed tomography pulmonary angiography (CTPA) and echocardiography were performed in all patients. We performed a post hoc study, analyzing the 68 cases in which TnI was measured, at the discretion of the emergency room physician. Results: Patients included had a median age of 74 years and 50% were male. The patients with elevated TnI had a differentiated clinical profile, suggestive of more severe PTE. There was a significant correlation between TnI levels and systolic pulmonary artery pressure (r = 0.46, P <.001), the CTPA-measured pulmonary artery diameter (r = 0.48, P <.001), the CTPA-measured RV diameter (r = 0.47, P=.001) and the pulmonary vascular obstruction index (r = 0.39, P=.001). Conclusion: The higher levels of TnI in patients with hemodynamically stable PTE predicts the existence of more severe PE in hemodynamically-stable patients. This biomarker could be used in the clinical practice to select those patients who might require more intensive monitoring or additional complementary studies. (c) 2010 Elsevier Espana, S.L. All rights reserved.