High sensitive troponin I sensitivity in determining disease severity in pulmonary embolism

Pulmonary embolism (PE) is an emergency clinic that develops as a result of sudden occlusion of the pulmonary arteries by embolizing material. It ranks 3rd among cardiovascular syndromes in the world. It is a completely reversible disease with rapid diagnosis and appropriate treatment. It most commonly develops as a result of the rupture of the thrombus material formed in the deep veins of the thigh, reaching the pulmonary arteries through the venous circulation. This clinical condition may be asymptomatic or result in shock and sudden death. And the development of this clinical condition may vary depending on the patient's hemodynamic reserve, thrombus load, and additional diseases. Therefore, in this study, we aimed to investigate the sensitivity of newly widespread hsTnI in determining the severity of the disease. A total of 92 inpatients or outpatients diagnosed with PE proven by CTPA were included in this study. The mean age of the cases was 61.9 (age range 18-96), and 50 (54.4%) were female and 42 (45.6%) were male. Age, gender, vital signs, hsTnI, NT-proBNP, D-Dimer, complete blood count and routine biochemical test results, admission complaints, background information and treatment outcome (outpatient follow-up, service admission, follow-up through consultation, intensive care admission) of the cases, death) was recorded. Mortality of the patients in one month period was determined by communicating with the Death Notification System and patient relatives. At the beginning of the study, the cases were evaluated using the ESC guideline mortality risk determination system; divided into 4 groups as low, medium low, medium high and high. Afterwards, the groups were combined and the intermediate-low and low-risk groups were called low, the intermediate-high and high-risk groups were called high-mortality risk groups. While 41 (44.5%) of the cases were in the high-risk group (high and medium-high risk), 51 (55.4%) were low risk (medium-low and low risk). In this study, the hsTnI value in patients with acute PE was found to be significantly higher in the high-mortality-risk group than in the low-mortality-risk group. (p<0.05). The mean of NT-proBNP was found to be statistically significantly higher in the high-risk group (p<0.05). However, no similar elevation was observed for hsTnI in the comparison of ex cases and high-risk groups. In the analysis performed in terms of right space width and sPAB in ECO, a significant difference was observed between low and high mortality risk groups (p<0.05). Diabetes Mellitus cases were found to be higher in the high mortality risk group. This situation was found to be statistically significant (p<0.05). The obesity diagnosis was significantly higher in the low-risk group (p<0.05). Half of the case group with Ex had a diagnosis of DM. In the correlation analysis, a moderate positive correlation was found between NT-proBNP and D-Dimer (r = 0.320, p < 0.05). However, no correlation was observed between hsTnI and D-Dimer, and between hsTnI and NT-proBNP. There was no correlation between PESI and hsTnI in the entire study group. However, there was a moderate positive correlation between PESI and hsTnI in the low-risk group (r= 0.328, p=0.019). Mortality could not be compared in the study due to the number of cases with Ex and the insufficient number of cases in the entire study group. There is a need for comparative prospective studies with larger number of cases to be conducted on this subject.