engleski

Prognostic value of cardiac biomarkers and echocardiography in patients with acute pulmonary embolism

INTRODUCTION: Right ventricular dysfunction (RVD) is central hemodynamic event in acute pulmonary embolism (APE), and represents independent prognostic factor of adverse event. According to recent studies, echocardiography and cardiac biomarkers (cardiac troponins and natriuretic peptides) are useful tools in asessment of RVD. The aim of study was to evaluate prognostic value of echocardiography and cardiac biomarkers associated with early adverse outcome of APE patients. MATERIALS AND METHODS: This was a single-center prospective study of APE patients conducted from September 2006 to November 2008 at Intensive Care Unit (ICU) in University Hospital Sisters of Mercy in Zagreb, Croatia. The study population included 104 patients. The diagnosis of APE was confirmed in all patients using spiral computed tomography. Patients were, according to European society of cardiology guidelines, divided into three severity groups: high-risk (n=33 ; 31.7%), intermediate-risk (n=51 ; 49.1%) and low- risk (n=20 ; 19.2%). Brain-type natriuretic peptide (BNP), N- teminal proBNP and cardiac troponine T (cTnT) were measured at admission and 12, 24 and 72 hours after addmition. Echocardiography was performed within 24 hours after admission. Main outcome measure was in- hospital death. Differences in survival were analyzed with the Kaplan-Meier method, the results were compared with the use of log-rank test. A value of p<0.05 was taken as level of statistical significance. The association between risk factors and death was examined by means of univariate analysis. RESULTS: Among 104 patients 19 (18, 7%) died, none of whom was in low risk group (p<0, 001). Echocardiographic findings of RVD was associated with higher mortality, escpecially tricuspid regurgitation (p=0, 027). Initial BNP levels correlated better with outcome then the severity of APE (p=0, 003) unlike N-terminal proBNP levels (p=0.082). Serum concentractions of cTnT at admission showed good correlation with disease severitiy notably in high risk patients (p<0, 001) and was associated with higher mortality (p=0, 038). DISCUSSION: Our results indicate that palsma levels of BNP and cTnT and echocardiographic signs of RVD are associated with higher mortality in APE patients and therefore could play role in therapeutic strategy. Multivariate logistic regression analysis will be performed to estimate factors independently associated with death.

pulmonary embolism; right ventricular dysfunction; brain-type natriuretic peptide; cardiac troponine T; echocardiography

Doktorski studij Biomedicina i zdravstvo, Medicinski fakultet Sveučilišta u Zagrebu Sažeci istraživanja i prijedlozi istraživanja 2012.