Cardiac troponin I elevation in acute pulmonary embolism is associated with right ventricular dysfunction

OBJECTIVES The purpose of this study was to evaluate the prevalence and dia gnostic utility of cardiac troponin I to identify patients with right ventr icular (RV) dysfunction in pulmonary embolism. BACKGROUND Right ventricular overload resulting from elevated pulmonary res istance is a common finding in major pulmonary embolism. However, biochemic al markers to assess the degree of RV dysfunction have not been evaluated s o far. METHODS In this prospective, double-blind study we included 36 study patien ts diagnosed as having acute pulmonary embolism. RESULTS Among the whole study population, 14 patients (39%) had positive tr oponin I tests. Ten of 16 patients (62.5%) with RV dilatation had increased serum troponin I levels, while only 4 of 14 patients (28.6%) with elevated troponin I values had a normal RV diameter as assessed by echocardiography , indicating that positive troponin I tests were significantly associated w ith RV dilatation (p = 0.009). Patients with positive troponin I tests had significantly more segmental defects in ventilation/perfusion lung scans th an patients with normal serum troponin I (p = 0.0002). CONCLUSIONS Our data demonstrate that more than one-third of patients clini cally diagnosed as having pulmonary embolism presented with elevated serum troponin I concentrations. Troponin I tests helped to identify patients wit h RV dilatation who had significantly more segmental defects in lung scans. Thus, troponin I assays are useful to detect minor myocardial damage in pu lmonary embolism. (C) 2000 by the American College of Cardiology.