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Highly sensitive troponin T assay in normotensive patients with acute pulmonary embolism.
MedLine Citation:
PMID:  20584774     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
AIMS: To assess the role of cardiac troponin T (cTnT) levels on admission using a new, highly sensitive assay (hsTnT) in the risk assessment of normotensive patients with acute pulmonary embolism (PE).
METHODS AND RESULTS: We prospectively studied 156 consecutive normotensive patients with confirmed PE. The prognostic value of hsTnT at baseline was compared with the conventional cTnT troponin assay and with N-terminal pro-brain natriuretic peptide concentrations. Long-term follow-up was available for 153 patients (98.1%). Highly sensitive troponin T values ranged from 0.001 to 357.2 pg/mL [median 27.2 (25th-75th percentile 9.4-69.4) pg/mL]. Overall, 100 patients (64%) had hsTnT > or =14 pg/mL. Baseline hsTnT was higher in patients with an adverse 30-day outcome (> or =1: death, need for catecholamines, endotracheal intubation, or cardiopulmonary resuscitation) compared with an uncomplicated course [71.7 (35.5-117.9) vs. 26.4 (9.2-68.2) pg/mL; P = 0.027]. The cut-off value of 14 pg/mL showed an excellent prognostic sensitivity and negative predictive value (both 100%). In comparison, as many as 50% of the patients with an adverse early outcome would have been misclassified as low risk by cTnT (cut-off 0.03 ng/mL). Logistic regression indicated a two-fold increase in the risk of an adverse outcome for each increase of hsTnT by 1SD of the natural logarithm (P = 0.037). Patients with elevated hsTnT levels had a reduced probability of long-term survival (P = 0.029 by log-rank); by Cox's regression analysis, hsTnT was the only laboratory biomarker predicting an elevated risk of death over the long term.
CONCLUSION: Highly sensitive troponin T assays may be capable of improving risk stratification of non-high-risk PE.
Authors:
Mareike Lankeit; Dietrich Friesen; John Aschoff; Claudia Dellas; Gerd Hasenfuss; Hugo Katus; Stavros Konstantinides; Evangelos Giannitsis
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Publication Detail:
Type:  Journal Article     Date:  2010-06-28
Journal Detail:
Title:  European heart journal     Volume:  31     ISSN:  1522-9645     ISO Abbreviation:  Eur. Heart J.     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-08-02     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8006263     Medline TA:  Eur Heart J     Country:  England    
Other Details:
Languages:  eng     Pagination:  1836-44     Citation Subset:  IM    
Affiliation:
Department of Cardiology and Pulmonology, University of Göttingen, 37099 Göttingen, Germany. mareike.lankeit@med.uni-goettingen.de
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