Prevalance and prognostic significance of elevated cardiac biomarkers (troponin,myoglobin and brain natriuretic peptid) in patients with acute pulmonary thromboembolism, and their relationship with right ventricular dysfunction

SUMMARYPREVALANCE AND PROGNOSTIC SIGNIFICANCE OF ELEVATEDCARDIAC BIOMARKERS (TROPONIN, MYOGLOBIN AND BRAINNATRIURETİC PEPTIDE) IN PATIENTS WITH ACUTE PULMONARYTHROMBOEMBOLISM, AND THEIR RELATIONSHIP WITH RIGHTVENTRICULAR DYSFUNCTIONHemodynamic status and right ventricular dysfunction (RVD) are veryimportant in determining prognosis and choice of treatment in patients withpulmonary thromboembolism (PTE). Due to the critical data provided,echocardiography (ECHO) has got significance particularly in the diagnosis ofmassive pulmonary embolism. In our study, we have investigated the relationshipbetween increased cardiac biomarkers and RVD, as an alternative to ECHO, and theirprognostic value in patient with PTE.Fifty consecutive patients with confirmed acute PTE were included in thestudy. At the admission and 8th and 24th hour after hospitalization, serum cTnI andBNP and MYG levels were measured. ECHO was performed in all patients at thetime of admission to detect possible RVD. All patients were followed up in terms ofthe hospital mortality, major hospital complications and 6-month mortality rates.Fifty-six percent of the patients had elevated cTnI, 76% of patients hadelevated BNP, and 46% patients had elevated MYG. Besides, RVD was detected in50% of the patients. Thirty percent developed at least one of the major complications94such as cardiogenic shock and need for mechanical ventilation. Forty-six percent ofthese patients died during their hospital stay. While significant relationship betweenthe elevated cTnI and BNP levels, and RVD were detected, there was no significantrelationship between the elevated MYG and RVD. While the relationship betweenelevated cTnI and MYG concentrations and hospital mortality is significant, therewas no relationship between the increased BNP and hospital mortality. However, therelationship between the increased cTnI, BNP and MYG levels, and major hospitalcomplications were significant. Among the multiple parameters evaluated, onlyelevated cTnI level was found as a powerful independent predictor of hospitalmortality, major hospital complications and 6-month mortality.As a result, we found that increased cardiac biomarkers indicated RVD andthey were important prognostic factors for major hospital complications includinghospital mortality. We think that all patients with elevated cardiac biomarker levelsshould be followed closely in terms of massive PTE, and should be evaluated forthrombolytic treatmentKeywords: Acute pulmonary thromboembolism, right ventriculardysfunction, elevated cardiac biomarkers95