| Combined risk stratification with computerized tomography /echocardiography and biomarkers in patients with normotensive pulmonary embolism. | |
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MedLine Citation:
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PMID: 20920821 Owner: NLM Status: In-Process |
Abstract/OtherAbstract:
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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. |
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Authors:
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Savas Ozsu; Kayıhan Karaman; Ahmet Mentese; Asiye Ozsu; S Caner Karahan; Ismet Durmus; Funda Oztuna; Polat Kosucu; Yilmaz Bulbul; Tevfik Ozlu |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Thrombosis research Volume: 126 ISSN: 1879-2472 ISO Abbreviation: Thromb. Res. Publication Date: 2010 Dec |
Date Detail:
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Created Date: 2010-12-03 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0326377 Medline TA: Thromb Res Country: United States |
Other Details:
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Languages: eng Pagination: 486-92 Citation Subset: IM |
Copyright Information:
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Copyright © 2010 Elsevier Ltd. All rights reserved. |
Affiliation:
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Karadeniz Technical University, School of Medicine, Department of Chest, Trabzon, Turkey. savasozsu@gmail.com |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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