Increased troponin I predicts in-hospital occurrence of hemodynamic instability in patients with sub-massive or non-massive pulmonary embolism independent to clinical, echocardiographic and laboratory information

Giovanni Gallotta, Vittorio Palmieri, Vincenzo Piedimonte, Domenico Rendina, Silvana De Bonis, Vittorio Russo, Aldo Celentano, Matteo N D Di Minno, Alfredo Postiglione, Giovanni Di Minno

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Abstract

Introduction: Whether in patients with acute central sub-massive or non-massive pulmonary embolism, mild troponin I increase (> 0.03 μg/L) predicts in-hospital occurrence of hemodynamic instability and death independent to prognostically relevant clinical, laboratory and echocardiographic information is not fully established. Methods and results: We evaluated consecutively patients admitted to the Emergency Room for pulmonary embolism; those in stable hemodynamics in whom central pulmonary embolism was confirmed by spiral-computed tomography were recruited. All participants underwent standardized study protocol, including clinical and diagnostic evaluation for assessment of severity of pulmonary embolism; therapy was established accordingly; troponin I was measured, but treatment protocol was not affected by knowledge of troponin I levels. Of 90 patients enrolled in the study, 33 (37%) developed hemodynamic instability during hospitalization (on average, 90 h ± 20 from admission). Troponin I was > 0.03 μg/L in 56% of the study population at admission, and predicted occurrence of hemodynamic instability during hospitalization (adjusted hazard ratio 9.8, 95% confidence interval 1.2-79.2), independent to age, gender, co-morbidity, systolic blood pressure, CK-MB, echocardiographic right ventricular dysfunction and other covariates. Twelve patients died during hospitalization (mean time to event 107 h ± 24 from admission); troponin I > 0.03 μg/L predicted mortality in univariate analysis, but not after accounting for age, sex and clinical variables. Nevertheless, higher troponin as continuous variable correlated with higher likelihood of in-hospital death (adjusted likelihood ratio 2.2/μg/L, 95% confidence interval 1.1-4.3) in multivariate analysis. In a further multivariate model, CK-MB predicted mortality independent of covariates and troponin I. Conclusions: In patients with acute central sub-massive or non-massive pulmonary embolism, even mild increase in troponin I > 0.03 μg/L may provide relevant short-term prognostic information independent to clinical, laboratory and echocardiographic data.

Original languageEnglish
Pages (from-to)351-357
Number of pages7
JournalInternational Journal of Cardiology
Volume124
Issue number3
DOIs
Publication statusPublished - Mar 14 2008

Fingerprint

Troponin I
Pulmonary Embolism
Hemodynamics
Hospitalization
Clinical Protocols
Confidence Intervals
Blood Pressure
Right Ventricular Dysfunction
Troponin
Mortality
Spiral Computed Tomography
Hospital Emergency Service
Multivariate Analysis
Morbidity
Population

Keywords

  • Outcome
  • Pulmonary embolism
  • Troponin

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Increased troponin I predicts in-hospital occurrence of hemodynamic instability in patients with sub-massive or non-massive pulmonary embolism independent to clinical, echocardiographic and laboratory information. / Gallotta, Giovanni; Palmieri, Vittorio; Piedimonte, Vincenzo; Rendina, Domenico; De Bonis, Silvana; Russo, Vittorio; Celentano, Aldo; Di Minno, Matteo N D; Postiglione, Alfredo; Di Minno, Giovanni.

In: International Journal of Cardiology, Vol. 124, No. 3, 14.03.2008, p. 351-357.

Research output: Contribution to journalArticle

Gallotta, Giovanni ; Palmieri, Vittorio ; Piedimonte, Vincenzo ; Rendina, Domenico ; De Bonis, Silvana ; Russo, Vittorio ; Celentano, Aldo ; Di Minno, Matteo N D ; Postiglione, Alfredo ; Di Minno, Giovanni. / Increased troponin I predicts in-hospital occurrence of hemodynamic instability in patients with sub-massive or non-massive pulmonary embolism independent to clinical, echocardiographic and laboratory information. In: International Journal of Cardiology. 2008 ; Vol. 124, No. 3. pp. 351-357.
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abstract = "Introduction: Whether in patients with acute central sub-massive or non-massive pulmonary embolism, mild troponin I increase (> 0.03 μg/L) predicts in-hospital occurrence of hemodynamic instability and death independent to prognostically relevant clinical, laboratory and echocardiographic information is not fully established. Methods and results: We evaluated consecutively patients admitted to the Emergency Room for pulmonary embolism; those in stable hemodynamics in whom central pulmonary embolism was confirmed by spiral-computed tomography were recruited. All participants underwent standardized study protocol, including clinical and diagnostic evaluation for assessment of severity of pulmonary embolism; therapy was established accordingly; troponin I was measured, but treatment protocol was not affected by knowledge of troponin I levels. Of 90 patients enrolled in the study, 33 (37{\%}) developed hemodynamic instability during hospitalization (on average, 90 h ± 20 from admission). Troponin I was > 0.03 μg/L in 56{\%} of the study population at admission, and predicted occurrence of hemodynamic instability during hospitalization (adjusted hazard ratio 9.8, 95{\%} confidence interval 1.2-79.2), independent to age, gender, co-morbidity, systolic blood pressure, CK-MB, echocardiographic right ventricular dysfunction and other covariates. Twelve patients died during hospitalization (mean time to event 107 h ± 24 from admission); troponin I > 0.03 μg/L predicted mortality in univariate analysis, but not after accounting for age, sex and clinical variables. Nevertheless, higher troponin as continuous variable correlated with higher likelihood of in-hospital death (adjusted likelihood ratio 2.2/μg/L, 95{\%} confidence interval 1.1-4.3) in multivariate analysis. In a further multivariate model, CK-MB predicted mortality independent of covariates and troponin I. Conclusions: In patients with acute central sub-massive or non-massive pulmonary embolism, even mild increase in troponin I > 0.03 μg/L may provide relevant short-term prognostic information independent to clinical, laboratory and echocardiographic data.",
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T1 - Increased troponin I predicts in-hospital occurrence of hemodynamic instability in patients with sub-massive or non-massive pulmonary embolism independent to clinical, echocardiographic and laboratory information

AU - Gallotta, Giovanni

AU - Palmieri, Vittorio

AU - Piedimonte, Vincenzo

AU - Rendina, Domenico

AU - De Bonis, Silvana

AU - Russo, Vittorio

AU - Celentano, Aldo

AU - Di Minno, Matteo N D

AU - Postiglione, Alfredo

AU - Di Minno, Giovanni

PY - 2008/3/14

Y1 - 2008/3/14

N2 - Introduction: Whether in patients with acute central sub-massive or non-massive pulmonary embolism, mild troponin I increase (> 0.03 μg/L) predicts in-hospital occurrence of hemodynamic instability and death independent to prognostically relevant clinical, laboratory and echocardiographic information is not fully established. Methods and results: We evaluated consecutively patients admitted to the Emergency Room for pulmonary embolism; those in stable hemodynamics in whom central pulmonary embolism was confirmed by spiral-computed tomography were recruited. All participants underwent standardized study protocol, including clinical and diagnostic evaluation for assessment of severity of pulmonary embolism; therapy was established accordingly; troponin I was measured, but treatment protocol was not affected by knowledge of troponin I levels. Of 90 patients enrolled in the study, 33 (37%) developed hemodynamic instability during hospitalization (on average, 90 h ± 20 from admission). Troponin I was > 0.03 μg/L in 56% of the study population at admission, and predicted occurrence of hemodynamic instability during hospitalization (adjusted hazard ratio 9.8, 95% confidence interval 1.2-79.2), independent to age, gender, co-morbidity, systolic blood pressure, CK-MB, echocardiographic right ventricular dysfunction and other covariates. Twelve patients died during hospitalization (mean time to event 107 h ± 24 from admission); troponin I > 0.03 μg/L predicted mortality in univariate analysis, but not after accounting for age, sex and clinical variables. Nevertheless, higher troponin as continuous variable correlated with higher likelihood of in-hospital death (adjusted likelihood ratio 2.2/μg/L, 95% confidence interval 1.1-4.3) in multivariate analysis. In a further multivariate model, CK-MB predicted mortality independent of covariates and troponin I. Conclusions: In patients with acute central sub-massive or non-massive pulmonary embolism, even mild increase in troponin I > 0.03 μg/L may provide relevant short-term prognostic information independent to clinical, laboratory and echocardiographic data.

AB - Introduction: Whether in patients with acute central sub-massive or non-massive pulmonary embolism, mild troponin I increase (> 0.03 μg/L) predicts in-hospital occurrence of hemodynamic instability and death independent to prognostically relevant clinical, laboratory and echocardiographic information is not fully established. Methods and results: We evaluated consecutively patients admitted to the Emergency Room for pulmonary embolism; those in stable hemodynamics in whom central pulmonary embolism was confirmed by spiral-computed tomography were recruited. All participants underwent standardized study protocol, including clinical and diagnostic evaluation for assessment of severity of pulmonary embolism; therapy was established accordingly; troponin I was measured, but treatment protocol was not affected by knowledge of troponin I levels. Of 90 patients enrolled in the study, 33 (37%) developed hemodynamic instability during hospitalization (on average, 90 h ± 20 from admission). Troponin I was > 0.03 μg/L in 56% of the study population at admission, and predicted occurrence of hemodynamic instability during hospitalization (adjusted hazard ratio 9.8, 95% confidence interval 1.2-79.2), independent to age, gender, co-morbidity, systolic blood pressure, CK-MB, echocardiographic right ventricular dysfunction and other covariates. Twelve patients died during hospitalization (mean time to event 107 h ± 24 from admission); troponin I > 0.03 μg/L predicted mortality in univariate analysis, but not after accounting for age, sex and clinical variables. Nevertheless, higher troponin as continuous variable correlated with higher likelihood of in-hospital death (adjusted likelihood ratio 2.2/μg/L, 95% confidence interval 1.1-4.3) in multivariate analysis. In a further multivariate model, CK-MB predicted mortality independent of covariates and troponin I. Conclusions: In patients with acute central sub-massive or non-massive pulmonary embolism, even mild increase in troponin I > 0.03 μg/L may provide relevant short-term prognostic information independent to clinical, laboratory and echocardiographic data.

KW - Outcome

KW - Pulmonary embolism

KW - Troponin

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