Pulmonary embolism: CT signs and cardiac biomarkers for predicting right ventricular dysfunction.
نویسندگان
چکیده
The aim of this study was to prospectively evaluate the accuracy of quantitative cardiac computed tomography (CT) parameters and two cardiac biomarkers (N-terminal-pro-brain natriuretic peptide (NT-pro-BNP) and troponin I), alone and in combination, for predicting right ventricular dysfunction (RVD) in patients with acute pulmonary embolism. 557 consecutive patients with suspected pulmonary embolism underwent pulmonary CT angiography. Patients with pulmonary embolism also underwent echocardiography and NT-pro-BNP/troponin I serum level measurements. Three different CT measurements were obtained (right ventricular (RV)/left ventricular (LV)(axial), RV/LV(4-CH) and RV/LV(volume)). CT measurements and NT-pro-BNP/troponin I serum levels were correlated with RVD at echocardiography. 77 patients with RVD showed significantly higher RV/LV ratios and NT-pro-BNP/troponin I levels compared to those without RVD (RV/LV(axial) 1.68 ± 0.84 versus 1.00 ± 0.21; RV/LV(4-CH) 1.52 ± 0.45 versus 1.01 ± 0.21; RV/LV(volume) 1.97 ± 0.53 versus 1.07 ± 0.52; serum NT-pro-BNP 6,372 ± 2,319 versus 1,032 ± 1,559 ng · L(-1); troponin I 0.18 ± 0.41 versus 0.06 ± 0.18 g · L(-1)). The area under the curve for the detection of RVD of RV/LV(axial), RV/LV(4-CH), RV/LV(volume), NT-pro-BNP and troponin I were 0.84, 0.87, 0.93, 0.83 and 0.70 respectively. The combination of biomarkers and RV/LV(volume) increased the AUC to 0.95 (RV/LV(volume) with NT-pro-BNP) and 0.93 (RV/LV(volume) with troponin I). RV/LV(volume) is the most accurate CT parameter for identifying patients with RVD. A combination of RV/LV(volume) with NT-pro-BNP or troponin I measurements improves the diagnostic accuracy of either test alone.
منابع مشابه
Prognostic value of right ventricular dysfunction in patients with haemodynamically stable pulmonary embolism: a systematic review.
AIMS To determine the prognostic value of right ventricular (RV) dysfunction assessed by echocardiography or spiral computed tomography (CT), or by increased levels of cardiac biomarkers [troponin, brain natriuretic peptide (BNP) and pro-BNP] in patients with haemodynamically stable pulmonary embolism (PE). METHODS AND RESULTS We included all studies published between January 1985 and October...
متن کاملسنجش مقادیر تروپونین ? قلبی در بیماران مبتلا به آمبولی حاد ریه و ارتباط آن با اختلال عملکرد بطن راست
Background and purpose: Right ventricular dysfunction is common in major pulmonary embolisms. The purpose of this study was to evaluate the prevalence and diagnostic utility of cardiac troponin I and also to identify patients with RV dysfunction in pulmonary embolism. Materials and methods: This study was conducted on 42 patients with pulmonary embolism in Ekbatan Hospital, in Hamedan city. ...
متن کاملDiagnostic Accuracy of Right Ventricular Dysfunction Markers in Normotensive Emergency Department Patients With Acute Pulmonary Embolism.
STUDY OBJECTIVE We determine the diagnostic accuracy of goal-directed echocardiography, cardiac biomarkers, and computed tomography (CT) in early identification of severe right ventricular dysfunction in normotensive emergency department patients with pulmonary embolism compared with comprehensive echocardiography. METHODS This was a prospective observational study of consecutive normotensive...
متن کاملCardiac biomarkers for risk stratification of patients with acute pulmonary embolism.
Patients with pulmonary embolism (PE) present with a wide spectrum of clinical acuity that necessitates different therapeutic strategies. Most patients maintain normal systolic arterial pressure and normal right ventricular function. With therapeutic levels of anticoagulation, they will likely have a benign clinical course. Unfortunately, some PE patients suffer rapid clinical deterioration wit...
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ورودعنوان ژورنال:
- The European respiratory journal
دوره 39 4 شماره
صفحات -
تاریخ انتشار 2012