Risk Stratification of Pulmonary Thromboembolism using Brain Natriuretic Peptide and Troponin I; a Brief Report Diagnostic value of serum troponin and natriuretic peptide levels in pulmonary thromboembolism
Archives of Academic Emergency Medicine,
Vol. 10 No. 1 (2022),
,
Page e8
https://doi.org/10.22037/aaem.v10i1.1453
Abstract
Introduction: Pulmonary thromboembolism (PTE) is one of the most prevalent medical disorders, with a notable annual fatality rate. This study aimed to evaluated the accuracy of serum pro-BNP and troponin I levels in PTE diagnosis.
Methods: This cross-sectional study was implemented on 267 patients with suspected PTE (sudden chest pain or sudden dyspnea) in Imam Reza Hospital in Mashhad, Iran. All patients underwent pulmonary computed tomography (CT) angiography (as the gold standard test) and their serum levels of troponin I and pro-BNP were measured. The screening performance characteristics of pro-BNP in detection of PTE cases were measured and reported using receiver operating characteristic (ROC) curve analysis.
Results: Two-hundred-sixty-seven patients with a mean age of 67.7 ±11.5 years were evaluated (60.1% male). PTE was confirmed via CT angiography in 121 patients. The area under the ROC curve of troponin I and pro-BNP in detection of PTE was 0.501 ng/mL and 0.972 pg/mL, respectively. The sensitivity and specificity of proBNP at the best cut-off point (100 pg/ml) were 85.4% and 80.2%, respectively. The sensitivity and specificity of troponin I at the best cut-off point (0.005 ng/ml) were 65.5% and 42%, respectively.
Conclusion: Due to the comparatively good sensitivity and specificity of proBNP in diagnosis of pulmonary thromboembolism, it can be employed as a diagnostic determinant in patients with suspected pulmonary thromboembolism along with other laboratory tests.
- Troponin
- Pulmonary Embolism
- Natriuretic Peptide
- Brain
- Computed Tomography Angiography
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References
Li H-L, Chan YC, Li N, Cui D, Cheng SW. Prevalence and predictor of pulmonary embolism in a cohort of chinese patients with acute proximal deep vein thrombosis. Annals of vascular surgery. 2020;63:293-7.
Gjonbrataj E, Kim JN, Gjonbrataj J, Jung HI, Kim HJ, Choi W-I. Risk factors associated with provoked pulmonary embolism. The Korean journal of internal medicine. 2017;32(1):95.
Miniati M, Prediletto R, Formichi B, Marini C, Di Ricco G, Tonelli L, et al. Accuracy of clinical assessment in the diagnosis of pulmonary embolism. American journal of respiratory and critical care medicine. 1999;159(3):864-71.
Pollack CV, Schreiber D, Goldhaber SZ, Slattery D, Fanikos J, O'Neil BJ, et al. Clinical characteristics, management, and outcomes of patients diagnosed with acute pulmonary embolism in the emergency department: initial report of EMPEROR (Multicenter Emergency Medicine Pulmonary Embolism in the Real World Registry). Journal of the American College of Cardiology. 2011;57(6):700-6.
Wells PS, Ginsberg JS, Anderson DR, Kearon C, Gent M, Turpie AG, et al. Use of a clinical model for safe management of patients with suspected pulmonary embolism. Annals of internal medicine. 1998;129(12):997-1005.
Daniels LB, Maisel AS. Natriuretic peptides. Journal of the American college of cardiology. 2007;50(25):2357-68.
Hutchinson KR, Guggilam A, Cismowski MJ, Galantowicz ML, West TA, Stewart Jr JA, et al. Temporal pattern of left ventricular structural and functional remodeling following reversal of volume overload heart failure. Journal of applied physiology. 2011;111(6):1778-88.
Rondelet B, Dewachter C, Kerbaul F, Kang X, Fesler P, Brimioulle S, et al. Prolonged overcirculation-induced pulmonary arterial hypertension as a cause of right ventricular failure. European heart journal. 2012;33(8):1017-26.
Kucher N, Printzen G, Goldhaber SZ. Prognostic role of brain natriuretic peptide in acute pulmonary embolism. Circulation. 2003;107(20):2545-7.
Lega J-C, Lacasse Y, Lakhal L, Provencher S. Natriuretic peptides and troponins in pulmonary embolism: a meta-analysis. Thorax. 2009;64(10):869-75.
Lankeit M, Friesen D, Aschoff J, Dellas C, Hasenfuß G, Katus H, et al. Highly sensitive troponin T assay in normotensive patients with acute pulmonary embolism. European heart journal. 2010;31(15):1836-44.
Giannitsis E, Katus HA. Risk stratification in pulmonary embolism based on biomarkers and echocardiography. Circulation. 2005;112(11):1520-1.
Meyer T, Binder L, Hruska N, Luthe H, Buchwald AB. Cardiac troponin I elevation in acute pulmonary embolism is associated with right ventricular dysfunction. Journal of the American College of Cardiology. 2000;36(5):1632-6.
Pruszczyk P, Bochowicz A, Torbicki A, Szulc M, Kurzyna M, Fijałkowska A, et al. Cardiac troponin T monitoring identifies high-risk group of normotensive patients with acute pulmonary embolism. Chest. 2003;123(6):1947-52.
Macrea M. Cardiac troponin T monitoring and acute pulmonary embolism. Chest 2004; 126: 655-656.
Members ATF, Konstantinides SV, Torbicki A, Agnelli G, Danchin N, Fitzmaurice D, et al. 2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism: The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC) Endorsed by the European Respiratory Society (ERS). European heart journal. 2014;35(43):3033-80.
Klok FA, Mos IC, Huisman MV. Brain-type natriuretic peptide levels in the prediction of adverse outcome in patients with pulmonary embolism: a systematic review and meta-analysis. American journal of respiratory and critical care medicine. 2008;178(4):425-30.
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