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Troponin I and right ventricular dysfunction for risk assessment in patients with nonmassive pulmonary embolism in the Emergency Department in combination with clinically based risk score

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Abstract

To determine whether troponin I (cTnI) and right ventricular (RV) dysfunction predict adverse in-hospital outcomes in patients admitted to the Emergency Department (ED) with definite nonmassive pulmonary embolism (PE) independent of and in addition to a recently validated clinical prognostic risk score. From a pool of 168 patients with suspected PE, 89 had nonmassive PE confirmed by spiral lung angio-computed tomography. By the clinical prognostic score, in our study sample, 14% had very low risk; 17% had low risk, 20% had intermediate risk, whereas high risk and very high risk were identified in 29 and 20%, respectively. Prevalence of elevated cTnI (>0.1 μg/L, 57%) at admission was comparable among patients grouped by clinical prognostic score (P = NS); echocardiographic RV dysfunction (54%) was more prevalent with intermediate or high clinical risk score (P < 0.02). Increased cTnI predicted primary end-point (development of hemodynamic instability, overall 33 cases, 37%) independent of and in addition to the clinical risk class and RV dysfunction (P < 0.01 for interaction). Fatal events (12 cases, 14%, 5 definite, 7 possible PE-related) were predicted by higher clinical risk score (P < 0.05). In patients with nonmassive central PE admitted to the ED, increased cTnI contributed to identifying those with increased risk of development of hemodynamic instability independent of and in addition to a validated clinically based risk score.

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Authors and Affiliations

  1. Cardiology Unit, “Ospedale dei Pellegrini”, ASL-Napoli 1, Naples, Italy

    Vittorio Palmieri & Aldo Celentano

  2. Department of Clinical and Experimental Medicine, “Federico II” University Hospital, University of Naples-School of Medicine, via Pansini 5, Building 1A, 80131, Naples, Italy

    Vittorio Palmieri, Giovanni Gallotta, Alfredo Postiglione, Stefania Martino, Matteo Nicola Dario Di Minno & Aldo Celentano

  3. Department of Emergency Medicine, “Antonio Cardarelli” Hospital, Naples, Italy

    Domenico Rendina, Silvana De Bonis & Vittorio Russo

Authors
  1. Vittorio Palmieri
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  2. Giovanni Gallotta
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  3. Domenico Rendina
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  4. Silvana De Bonis
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  5. Vittorio Russo
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  6. Alfredo Postiglione
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  7. Stefania Martino
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  8. Matteo Nicola Dario Di Minno
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  9. Aldo Celentano
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Correspondence to Vittorio Palmieri.

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Palmieri, V., Gallotta, G., Rendina, D. et al. Troponin I and right ventricular dysfunction for risk assessment in patients with nonmassive pulmonary embolism in the Emergency Department in combination with clinically based risk score. Intern Emerg Med 3, 131–138 (2008). https://doi.org/10.1007/s11739-008-0134-2

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  • DOI: https://doi.org/10.1007/s11739-008-0134-2

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