Combined risk stratification with computerized tomography /echocardiography and biomarkers in patients with normotensive pulmonary embolism


Ozsu S. S. , Karaman K., Mentese A. , Ozsu A., Karahan S. C. , Durmus I. , ...Daha Fazla

Thrombosis Research, cilt.126, sa.6, ss.486-492, 2010 (SCI Expanded İndekslerine Giren Dergi) identifier identifier identifier

  • Yayın Türü: Makale / Tam Makale
  • Cilt numarası: 126 Konu: 6
  • Basım Tarihi: 2010
  • Doi Numarası: 10.1016/j.thromres.2010.08.021
  • Dergi Adı: Thrombosis Research
  • Sayfa Sayıları: ss.486-492

Özet

Background: Right ventricular dysfunction (RVD) detected by computerized tomography (CT)/echocardiography or elevated biomarkers is associated with a poor prognosis for pulmonary embolism (PE). However, these prognostic factors have not previously been concomitantly elucidated in the same patient group. Methods: This prospective study included 108 consecutive patients with normotensive PE confirmed by CT pulmonary angiography (CTPA). On admission, patient serum NT-proBNP and troponin T (Tn-T) levels were measured, and echocardiography was performed within 24 hours after diagnosis of PE. Receiver operating characteristic (ROC) analysis was performed to determine the optimal echocardiographic end-diastolic diameters of the right ventricle, the ratio of the right ventricle to left ventricle (RV/LV ratio) on CTPA, and NT-proBNP and Tn-T cut-off levels with regard to prognosis. Results: All-cause 30-day mortality was 13% and PE-related mortality was 5.6%. RVD was defined as a right/left ventricular dimension ratio ≥ 1.1 on CTPA and RV > 30 mm on echocardiography by ROC analysis. A cut-off level of NT-proBNP ≤ 90 pmol/ml had a high positive predictive value of 98% for survival, whereas NT-proBNP > 300 and Tn-T ≥ 0.027 had a negative predictive value, for all-cause deaths, of 95% and 96%, respectively. PE mortality in patients with NT-proBNP > 300 and Tn-T ≥ 0.027 reached 64%. In univariable analysis, the combination of Tn-T ≥ 0.027 ng/ml with a echocardiographic RVD were the most significant predictors of overall mortality and PE-related death [HR: 14 (95% CI: 4.6-42,) and HR: 37.6 (95% CI: 4.4-324)], respectively. In multivariable Cox's regression analysis, NT-proBNP > 300 and Tn-T ≥ 0.027 HR: 26.5 (95% CI: 4.1-169.9, p < 0.001) were the best combination to predict all-cause of mortality. Conclusions: The combination of NT-proBNP and Tn-T clearly appears to be a better risk stratification predictor than biomarkers plus RVD on CT/ echocardiography in patients with normotensive PE. © 2010 Elsevier Ltd. All rights reserved.