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The role of cardiac biomarkers elevation in intermediate-high risk pulmonary embolism
Session:
Painel 9 - Doença Valvular 9
Speaker:
Maria Inês Fiúza Pires
Congress:
CPC 2020
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
Subtheme:
21.2 Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Inês Pires; Maria Luisa Gonçalves; João Miguel Santos; Joana Laranjeira Correia; Hugo Da Silva Antunes; José Costa Cabral; Inês Almeida
Abstract
<p>Background: Elevated troponin (T), a marker of myocardial injury, and elevated B-type natriuretic peptide (BNP), a sign of right ventricular (RV) dysfunction, have been used in pulmonary embolism (PE) risk assessment. 2014 ESC guidelines on PE defined intermediate-high (IH) risk category as evidence of both RV dysfunction on imaging and elevated cardiac biomarkers, either T or BNP. However, 2019 ESC guidelines give more emphasis to T in risk stratification. This study compares the therapy and prognosis of patients (P) with IH risk PE due to elevation in cardiac T with either normal or elevated BNP (T+BNP-/+) and P now classified as intermediate-low risk because of normal T and elevated BNP (T-BNP+).</p> <p>Methods: All P admitted for IH risk PE in an Intensive Cardiac Care Unit for 10 years were included. Follow-up (FU) was 2 years for all-cause mortality. Clinical, imaging and laboratory parameters were collected. Troponin I or BNP elevations were defined as concentrations above the laboratory reference range. Statistical analysis used chi-square and Mann-Whitney U tests, binary logistic regressions and Kaplan-Meier curves.</p> <p>Results: 195 P were studied (mean age 63±18 years; 37.4% male). Mean T levels were 1.3±9.2 ng/mL and mean BNP levels were 305±318 pg/mL. 173 (88.7%) P had T+BNP-/+ and 22 (11.3%) P had T-BNP+.</p> <p>At admission, P with T+BNP-/+ presented more frequently with dyspnea (p=0.038) or syncope (p=0.019); higher heart rate (p=0.020); lower arterial oxygen saturation (p=0.001); higher D-dimers (p=0.008) and creatinine (p=0.004); echocardiographic RV dilation (p=0.017); higher pulmonary arteries clot load (p=0.024) and higher Pulmonary Embolism Severity Index (PESI) (p=0.007). There was no difference in age, gender, TAPSE or in-hospital mortality between the 2 groups. T+BNP-/+ P were submitted more frequently to fibrinolytic treatment (53% vs. 27% with T-BNP+, p=0.024) and T+BNP-/+ was a predictor of fibrinolytic treatment (OR 2.99, 95%CI 1.119-8.021, p=0.029). This result was independent from PESI (OR 3.194, 95%CI 1.104-9.238, p=0.032).</p> <p>During FU there was no difference in mortality between the groups (Kaplan-Meier χ<sup>2</sup>=0.571; p=0.450).</p> <p>Conclusions: In IH risk PE, elevated cardiac T was associated with clinical, analytical and imaging risk features. Cardiac T elevation was also associated with necessity of fibrinolytic therapy, even after adjustment for PESI. However, in-hospital mortality and mortality during FU were similar between the groups. Therefore, although P with T-BNP+ have a similar short- and long-term prognosis than T+BNP-/+, recent changes in risk stratification might allow better identification of P that will require fibrinolysis.</p>
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