CLINICAL STUDY
Cardiac troponin I elevation in acute pulmonary embolism is associated with right ventricular dysfunction
Thomas Meyer, MD, PhD*,
Lutz Binder, MD ,
Nadine Hruska*,
Hilmar Luthe, PhD and
Arnd B. Buchwald, MD*
* Department of Cardiology, University of Göttingen, Göttingen, Germany
Department of Clinical Chemistry, University of Göttingen, Göttingen, Germany
Manuscript received October 25, 1999;
revised manuscript received April 11, 2000,
accepted June 15, 2000.
Reprint requests and correspondence: Dr. Thomas Meyer, Center of Internal Medicine, University of Göttingen, Robert-Koch-Str. 40, D-37075 Göttingen, Germany
OBJECTIVES
The purpose of this study was to evaluate the prevalence and diagnostic utility of cardiac troponin I to identify patients with right ventricular (RV) dysfunction in pulmonary embolism.
BACKGROUND
Right ventricular overload resulting from elevated pulmonary resistance is a common finding in major pulmonary embolism. However, biochemical markers to assess the degree of RV dysfunction have not been evaluated so far.
METHODS
In this prospective, double-blind study we included 36 study patients diagnosed as having acute pulmonary embolism.
RESULTS
Among the whole study population, 14 patients (39%) had positive troponin I tests. Ten of 16 patients (62.5%) with RV dilatation had increased serum troponin I levels, while only 4 of 14 patients (28.6%) with elevated troponin I values had a normal RV diameter as assessed by echocardiography, indicating that positive troponin I tests were significantly associated with RV dilatation (p = 0.009). Patients with positive troponin I tests had significantly more segmental defects in ventilation/perfusion lung scans than patients with normal serum troponin I (p = 0.0002).
CONCLUSIONS
Our data demonstrate that more than one-third of patients clinically diagnosed as having pulmonary embolism presented with elevated serum troponin I concentrations. Troponin I tests helped to identify patients with RV dilatation who had significantly more segmental defects in lung scans. Thus, troponin I assays are useful to detect minor myocardial damage in pulmonary embolism.
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Abbreviations and Acronyms
| | CHD | = coronary heart disease | | CK | = creatine kinase | | RBBB | = right bundle branch block | | RV | = right ventricular, right ventricle |
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