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Prognostic value of cardiac biomarkers in acute pulmonary embolism: can it add something?
Session:
Posters - F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Speaker:
Fabiana Duarte
Congress:
CPC 2021
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
Subtheme:
21.6 Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure – Clinical
Session Type:
Posters
FP Number:
---
Authors:
Fabiana Silva Duarte ; Maria Inês Barradas; Luís Oliveira; Cátia Serena; Raquel Dourado; António Fontes; André Monteiro; Carla Almeida; Carina Machado; Emília Santos; Nuno Pelicano; Miguel Pacheco; Anabela Tavares; Dinis Martins
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Calibri",sans-serif"><strong>Introduction:</strong> Acute pulmonary thromboembolism (PE) is a life-threatening disease. Mortality in PE still remains very high in spite of progress in diagnostic tools. Cardiac biomarkers like lactate, NT-proBNP and troponin I have been reported to predict prognosis of acute PE however, the prognostic importance of these factors on long-term mortality is not known. </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Calibri",sans-serif"><strong>Objectives:</strong> To assess the prognostic role of biomarkers lactate, NT-proBNP and troponin I in acute PE.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Calibri",sans-serif"><strong>Methods:</strong> We retrospectively assessed 131 consecutive patients diagnosed with acute PE between January 2017 and October 2020. Prognostic impact of cardiac biomarkers lactate, NT-proBNP and troponin was assessed. Receiver operating characteristic curve analysis, survival analysis and multivariate Cox proportional hazards analysis were implemented as statistical analysis methods.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Calibri",sans-serif"><strong>Results:</strong> Out of 131 patients with acute PE, the median age was 67.6±15.3 years and 71.0% were female. Mean follow-up was 44.8± 37.3 months. Overall in-hospital mortality was 8.4%, 30-day mortality 13.0% and 1-year mortality 20.6%. Twenty-six patients (19.8%) had a recent hospitalization and 21 (16.0%) a medical history of active cancer. ROC curves shown that lactate has a good discriminatory power for in-hospital mortality, with an area under the curve (AUC) of 0.84 and p-value 0.001, unlike NT-proBNP (AUC 9.45, p-value 0.76) and troponin (AUC 0.64, p-value 0.12). Serum lactate equal or superior to 2.05 mmol/L were associated with higher in-hospital mortality (odds ratio [OR] 23.1, 95% confidence interval (CI) 2.8-187.7), when compared with lower levels. The impact of this parameter was independent of hypotension, tachycardia or active neoplasia (p-value 0.006, OR 21.3, 95% CI 2.4-187.3).</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Calibri",sans-serif"><strong>Conclusions:</strong> This study revealed that lactate has a better discriminatory power when compared to NT-proBNP and troponin in predicting prognosis in acute PE patients. Its routinely addition to current stratification tools could be of interest.</span></span></p>
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