Abstract
Introduction
Moderate to large acute pulmonary embolism (PE) is associated with a rise in serum cardiac troponins. The proposed mechanism is through acute right heart overload. Acute right ventricular failure is associated with a higher mortality in those with PE.
Aims
In patients with CT Pulmonary Angiogram (CTPA) confirmed PE, we studied the association between raised troponin I, right ventricular strain and mortality.
Methods
We conducted a retrospective cohort study in 369 patients over 1 year with a CTPA diagnosis of PE in those with troponin I measurements and assessed the association between elevated troponin I (>0.05 ng/l), right ventricular dilatation on CT (right ventricular to left ventricular ratio > 1.0) and clot burden (Miller score).
Results
106 patients had troponin I measurements. Of those 58 (55%) were positive. The degree of elevation of troponin I is associated with an increase in the RV:LV axial ratio on CT.
RV:LV <1 – average troponin I 0.57 ng/l.
RV:LV 1-1.5 – average troponin I 0.68 ng/l.
RV:LV >1.5 – average troponin I 1.64 ng/l.
Conclusions
We conclude that there is an association between the level of Troponin I, clot burden and the degree of right ventricular dysfunction in acute PE. Thus Troponin I could be used to identify those most at risk of cardiovascular collapse in acute PE.
- © 2014 ERS