Abstract
Acute pulmonary embolism (PE) presents with a wide clinical spectrum of acuity. Patients with anatomically small PE and no underlying cardiopulmonary disease have an excellent prognosis. Massive PE with cardiogenic shock is life-threatening, with a high mortality rate. However, most patients with PE have clinical presentations that are at neither of these extremes. These patients constitute the majority of patients with PE. They require rapid assessment of prognosis in order to optimize therapy. These patients will benefit from early and accurate risk stratification. Biomarkers of necrosis (troponin) and hemodynamic stress (B-type natriuretic peptide) have both proven useful for assessing prognosis in patients with PE. Right ventricular microinfarction and right ventricular shear stress are the most likely explanations for the rise in troponin and natriuretic peptides, respectively. Although these biomarkers do not offer incremental prognostic information in patients who present with cardiogenic shock owing to PE, they may be useful in guiding additional testing and the aggressiveness of therapy. Future investigation will assess these biomarkers in formal prospective management trials.
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References
Wicki J, Perrier A, Perneger TV, Bounameaux H, Junod AF. Predicting adverse outcome in patients with acute pulmonary embolism: a risk score. Thromb Haemost 2000;84:548–552.
Goldhaber SZ, Elliott CG. Acute pulmonary embolism: Part II: risk stratification, treatment, and prevention. Circulation 2003;108:2834–2838.
Daniel KR, Courtney DM, Kline JA. Assessment of cardiac stress from massive pulmonary embolism with 12-lead ECG. Chest 2001;120:474–481.
Elliott CG, Goldhaber SZ, Visani L, DeRosa M. Chest radiographs in acute pulmonary embolism: results from the International Cooperative Pulmonary Embolism Registry. Chest 2000;118:33–38.
Schoepf UJ, Goldhaber SZ, Costello P. Spiral CT for acute pulmonary embolism. Circulation 2004;109:2160–2167.
Quiroz R, Kucher N, Schoepf UJ, et al. Right ventricular enlargement on chest computed tomography: prognostic role in acute pulmonary embolism. Circulation 2004;109:2401–2404.
Grifoni S, Olivotto I, Cecchini P, et al. Short-term clinical outcome of patients with acute pulmonary embolism, normal blood pressure, and echocardiographic right ventricular dysfunction. Circulation 2000; 101:2817–2822.
Goldhaber SZ. Echocardiography in the management of pulmonary embolism. Ann Intern Med 2002; 136:691–700.
Lualdi JC, Goldhaber SZ. Right ventricular dysfunction after acute pulmonary embolism: pathophysiologic factors, detection, and therapeutic implications. Am Heart J 1995;130:1276–1282.
Kucher N, Goldhaber SZ. Cardiac biomarkers for risk stratification of patients with acute pulmonary embolism. Circulation 2003;108:2191–2194.
Goldhaber SZ, Elliott CG. Acute pulmonary embolism: Part I: Epidemiology, pathophysiology, and diagnosis. Circulation 2003;108:2726–2729.
Goldhaber SZ. Cardiac biomarkers in pulmonary embolism. Chest 2003;123:1782–1784.
Wood KE. Major pulmonary embolism: review of a pathophysiologic approach to the golden hour of hemodynamically significant pulmonary embolism. Chest 2002;121:877–905.
Pacouret G, Schellenberg F, Hamel E, Charbonnier B, Mouray H. Troponine 1 dans l’embolie pulmonaire aigue massive: résultas d’une série prospective. Presse Medicale 1998;27:1627.
Meyer T, Binder L, Hruska, N, Luthe H, Buchwald AB. Cardiac troponin I elevation in acute pulmonary embolism is associated with right ventricular dysfunction. J Am Coll Cardiol 2000;36:1632–1636.
Giannitsis E, Muller-Bardorff M, Kurowski V, et al. Independent prognostic value of cardiac troponin T in patients with confirmed pulmonary embolism. Circulation 2000;102:211–217.
Konstantinides S, Geibel A, Olschewski M, et al. Importance of cardiac troponins I and T in risk stratification of patients with acute pulmonary embolism. Circulation 2002;106:1263–1268.
Douketis JD, Crowther MA, Stanton EB, Ginsberg JS. Elevated cardiac troponin levels in patients with submassive pulmonary embolism. Arch Intern Med 2002;162:79–81.
Pruszczyk P, Bochowicz A, Torbicki A, et al. Cardiac troponin T monitoring identifies high-risk group of normotensive patients with acute pulmonary embolism. Chest 2003;123:1947–1952.
Yalamanchili K, Sukhija R, Aronow WS, Sinha N, Fleisher AG, Lehrman SG. Prevalence of increased cardiac troponin I levels in patients with and without acute pulmonary embolism and relation of increased cardiac troponin I levels with in-hospital mortality in patients with acute pulmonary embolism. Am J Cardiol 2004;93:263, 264.
Jimenez CH, Kleinschmidt K. B-type natriuretic peptide: clinical utility in the emergency department and in-hospital setting. Clin Cardiol Consensus Rep August 1, 2003; pp. 1–12.
ten Wolde M, Tulevski II, Muilder JW, et al. Barin natriuretic peptide as a predictor of adverse outcome in patients with pulmonary embolism. Circulation 2003;107:2082–2084.
Kucher N, Printzen G, Goldhaber SZ. Prognostic role of BNP in acute pulmonary embolism. Circulation 2003;107:2545–2547.
Kucher N, Printzen G, Doernhoefer T, Windecker S, Meier B, Hess OM. Low pro-brain natriuretic peptide levels predict benign clinical outcome in acute pulmonary embolism. Circulation 2003;107:1576–1578.
Pruszczyk P, Kostrubiec M, Bochowicz A, et al. N-terminal pro-brain natriuretic peptide in patients with acute pulmonary embolism Eur Respir J 2003;22:1–5.
Kruger S, Graf J, Merx MW, et al. Brian natriuretic peptide predicts right heart failure in patients with acute pulmonary embolism. Am Heart J 2004;147:60–65.
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© 2006 Humana Press Inc., Totowa, NJ
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Goldhaber, S.Z. (2006). Is There a Role for Cardiac Troponin and Other Biomarkers in Patients With Pulmonary Embolism?. In: Morrow, D.A. (eds) Cardiovascular Biomarkers. Contemporary Cardiology. Humana Press. https://doi.org/10.1007/978-1-59745-051-5_9
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DOI: https://doi.org/10.1007/978-1-59745-051-5_9
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