Independent prognostic value of cardiac troponin T in patients with confirmed pulmonary embolism

Background-Cardiac troponin T (cTnT) is a sensitive and specific marker, al lowing the detection of even minor myocardial cell injury. in patients with severe pulmonary embolism (PE), myocardial ischemia may lead to progressiv e right ventricular dysfunction. It was therefore the purpose of this study to test the presence of cTnT and its prognostic implications in patients w ith confirmed PE. Methods and Results-Fifty-six patients with confirmed PE were enrolled in t his prospective study. PE was confirmed by pulmonary angiography, lung scan , or echocardiography and subsidiary analyses. Severity of PE was assessed by a clinical scoring system, and cTnT was measured within 12 hours after a dmission, cTnT was elevated (greater than or equal to 0.1 mu g/L) in 18 (32 %) patients with massive and moderate PE but not in patients with small PE. In-hospital death (odds ratio 29.6, 95% CI 3.3 to 265.3), prolonged hypote nsion and cardiogenic shock (odds ratio 11.4, 95% CI 2.1 to 63.4), and need for resuscitation (odds ratio 18.0, 95% CI 2.6 to 124.3) were more prevale nt in patients with elevated cTnT, cTnT-positive patients more often needed inotropic support (odds ratio 37.6, 95% CI 5.8 to 245.6) and mechanical ve ntilation (odds ratio 78.8, 95% CI 9.5 to 653.2). After adjustment, cTnT re mained an independent predictor of 30-day mortality (odds ratio 15.2, 95% C I 1.22 to 190.4). Conclusions-cTnT may improve risk stratification in patients with PE and ma y aid in the identification of patients in whom a more aggressive therapy m ay be warranted.