scholarly journals Cardiac troponin testing and the simplified Pulmonary Embolism Severity Index

2011 ◽  
Vol 106 (11) ◽  
pp. 978-984 ◽  
Author(s):  
David Spirk ◽  
Drahomir Aujesky ◽  
Marc Husmann ◽  
Daniel Hayoz ◽  
Thomas Baldi ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Cardiac Troponin ◽  
Prognostic Value ◽  
Troponin T ◽  
Characteristic Curve ◽  
Early Death ◽  
Severity Index ◽  
Highly Sensitive ◽  
Risk Patients ◽  
Highly Sensitive Troponin

SummaryA low simplified Pulmonary Embolism Severity Index (sPESI), defined as age ≤80 years and absence of systemic hypotension, tachycardia, hypoxia, cancer, heart failure, and lung disease, identifies low-risk patients with acute pulmonary embolism (PE). It is unknown whether cardiac troponin testing improves the prediction of clinical outcomes if the sPESI is not low. In the prospective Swiss Venous Thromboembolism Registry, 369 patients with acute PE and a troponin test (conventional troponin T or I, highly sensitive troponin T) were enrolled from 18 hospitals. A positive test result was defined as a troponin level above the manufacturers assay threshold. Among the 106 (29%) patients with low sPESI, the rate of mortality or PE recurrence at 30 days was 1.0%. Among the 263 (71%) patients with high sPESI, 177 (67%) were troponin-negative and 86 (33%) troponin-positive; the rate of mortality or PE recurrence at 30 days was 4.6% vs. 12.8% (p=0.015), respectively. Overall, risk assessment with a troponin test (hazard ratio [HR] 3.39, 95% confidence interval [CI] 1.38–8.37; p=0.008) maintained its prognostic value for mortality or PE recurrence when adjusted for sPESI (HR 5.80, 95%CI 0.76–44.10; p=0.09). The combination of sPESI with a troponin test resulted in a greater area under the receiver-operating characteristic curve (HR 0.72, 95% CI 0.63–0.81) than sPESI alone (HR 0.63, 95% CI 0.57–0.68) (p=0.023). In conclusion, although cardiac troponin testing may not be required in patients with a low sPESI, it adds prognostic value for early death and recurrence for patients with a high sPESI.

scholarly journals Combination of D-dimer and simplified pulmonary embolism severity index to improve prediction of hospital death in patients with acute pulmonary embolism

2020 ◽  
Vol 48 (10) ◽  
pp. 030006052096229
Author(s):  
Hai-Di Wu ◽  
Zi-Kai Song ◽  
Xiao-Yan Xu ◽  
Hong-Yan Cao ◽  
Qi Wei ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Operating Characteristic ◽  
Troponin T ◽  
Characteristic Curve ◽  
Severity Index ◽  
Hospital Death ◽  
Operating Characteristic Curve ◽  
Death Group ◽  
D Dimer

Objective To investigate whether the combination of D-dimer and simplified pulmonary embolism severity index (sPESI) could improve prediction of in-hospital death from pulmonary embolism (PE). Methods Patients with PE (n = 272) were divided into a surviving group (n = 249) and an in-hospital death group (n = 23). Results Compared with surviving patients, patients who died in hospital had significantly higher rates of hypotension and tachycardia, reduced SaO2 levels, elevated D-dimer and troponin T levels, higher sPESI scores, and were more likely to be classified as high risk. Elevated D-dimer levels and high sPESI scores were significantly associated with in-hospital death. Using thresholds for D-dimer and sPESI of 3.175 ng/mL and 1.5, respectively, the specificity for prediction of in-hospital death was 0.357 and 0.414, respectively, and the area under the receiver operating characteristic curve (AUC) was 0.665 and 0.668, respectively. When D-dimer and sPESI were considered together, the specificity for prediction of in-hospital death increased to 0.838 and the AUC increased to 0.74. Conclusions D-dimer and sPESI were associated with in-hospital death from PE. Considering D-dimer levels together with sPESI can significantly improve the specificity of predicting in-hospital death for patients with PE.

Measurement of High-Sensitivity Cardiac Troponin in Pulmonary Embolism: Useful Test or a Clinical Distraction

2019 ◽  
Vol 45 (08) ◽  
pp. 784-792
Author(s):  
Giuseppe Lippi ◽  
Emmanuel J. Favaloro ◽  
Peter Kavsak
Keyword(s):  
Pulmonary Embolism ◽  
Risk Stratification ◽  
Cardiac Troponin ◽  
Laboratory Tests ◽  
High Sensitivity ◽  
Severity Index ◽  
Adverse Outcomes ◽  
Incremental Value ◽  
Risk Patients ◽  
Acute Pe

AbstractThe ability to predict death or other unfavorable outcomes after an acute pulmonary embolism (PE) is challenging, with current available risk score models having relatively unsatisfactory prognostic performance in this area. For example, the simplified pulmonary embolism severity index (sPESI), the most frequently used stratification tool, misclassifies a significant percentage of low- and high-risk patients. This gap in care, along with the increasing clinical availability of high-sensitivity cardiac troponin (hs-cTn) laboratory tests and the recent emphasis on detecting myocardial injury, may foster further evaluation of hs-cTn testing in patients with acute PE. Our analysis of the current scientific literature on hs-cTn in patients with acute PE identified that hs-cTn testing may provide valuable information for predicting future adverse outcomes and mortality, independently from baseline clinical risk assessment. Although the risk of an adverse event is indeed higher in patients with higher sPESI scores, cTns retain their prognostic value also in those at low risk, suggesting that a combination of hs-cTn with sPESI may provide an incremental value over assessment of either variable alone. Accordingly, the future development of updated risk stratification models, with the inclusion of laboratory tests such as hs-cTn, may represent an enhanced approach for risk stratification in patients with acute PE. Additional research, however, is needed to verify whether the combination of cTns, specifically as measured with hs-cTn assays, with other biomarkers may further improve the current capacity to efficiently manage patients with acute PE.

scholarly journals The long-term prognostic value of highly sensitive cardiac troponin I in patients with acute pulmonary embolism

2017 ◽  
Vol 40 (12) ◽  
pp. 1271-1278 ◽  
Author(s):  
Katherine Lee Chuy ◽  
Emad Uddin Hakemi ◽  
Tareq Alyousef ◽  
Geetanjali Dang ◽  
Rami Doukky
Keyword(s):  
Pulmonary Embolism ◽  
Cardiac Troponin ◽  
Prognostic Value ◽  
Acute Pulmonary Embolism ◽  
Troponin I ◽  
Cardiac Troponin I ◽  
Highly Sensitive

Highly Sensitive Cardiac Troponin T Changes and Its Prognostic Value in Patients with Acute Stroke

2020 ◽  
Vol 11 (2) ◽  
Author(s):  
Nagwa M Doha ◽  
Mostafa S Melake ◽  
Ahmed M El-Kersh ◽  
Mohammed H Badr
Keyword(s):  
Acute Stroke ◽  
Cardiac Troponin ◽  
Prognostic Value ◽  
Troponin T ◽  
Cardiac Troponin T ◽  
Highly Sensitive

The Prognostic Value of Undetectable Highly Sensitive Cardiac Troponin I in Patients With Acute Pulmonary Embolism

CHEST Journal ◽  
2015 ◽  
Vol 147 (3) ◽  
pp. 685-694 ◽  
Author(s):  
Emad U. Hakemi ◽  
Tareq Alyousef ◽  
Geetanjali Dang ◽  
Jalal Hakmei ◽  
Rami Doukky
Keyword(s):  
Pulmonary Embolism ◽  
Cardiac Troponin ◽  
Prognostic Value ◽  
Acute Pulmonary Embolism ◽  
Troponin I ◽  
Cardiac Troponin I ◽  
Highly Sensitive

scholarly journals Highly Sensitive Troponin Assays and the Cardiology Community: A Love/Hate Relationship?

2011 ◽  
Vol 57 (6) ◽  
pp. 826-829 ◽  
Author(s):  
James A de Lemos ◽  
David A Morrow ◽  
Christopher R deFilippi
Keyword(s):  
Cardiac Troponin ◽  
Cardiovascular Health ◽  
Troponin I ◽  
Troponin T ◽  
Cardiac Injury ◽  
Improve Patient Care ◽  
Fourth Generation ◽  
Highly Sensitive ◽  
Highly Sensitive Troponin ◽  
Improve Patient

Abstract The development of highly sensitive assays for cardiac troponin T (hs-cTnT)4 and cardiac troponin I (hs-cTnI) represents the latest technological advance in a field that has witnessed continual progression toward more sensitive and more precise tools for detecting cardiac injury. The hs-cTnT assay, for example, can detect cTnT concentrations 10-fold lower than the current fourth-generation assay, with high precision at the myocardial infarction (MI) detection limit. Despite the potential for such evolution to improve patient care, clinicians, including practicing cardiologists, often find themselves poorly prepared for the introduction of more-sensitive assays, because they fail to consider the implications of increasing sensitivity on the interpretation of the test results. We believe that highly sensitive troponin assays offer new opportunities to improve cardiovascular health, but they also present challenges in the areas in which troponin testing is most commonly used today.

scholarly journals Independent Prognostic Value of Cardiac Troponin T in Patients With Confirmed Pulmonary Embolism

Circulation ◽  
2000 ◽  
Vol 102 (2) ◽  
pp. 211-217 ◽  
Author(s):  
Evangelos Giannitsis ◽  
Margit Müller-Bardorff ◽  
Volkhard Kurowski ◽  
Britta Weidtmann ◽  
Uwe Wiegand ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Cardiac Troponin ◽  
Prognostic Value ◽  
Troponin T ◽  
Cardiac Troponin T
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