Prognosis Based on Creatine Kinase Isoenzyme MB, Cardiac Troponin I, and Right Ventricular Size in Stable Patients With Acute Pulmonary Embolism

详细信息    查看全文

• 作者：Paul D. Stein MD^a ; ^c ; ^{steinp@trinity-health.org} ; Muhammad Janjua MD^d ; Fadi Matta MD^a ; ^c ; Pramod K. Pathak PhD^b ; Fadel Jaweesh MD^e ; Ahmad Alrifai MD^d ; Haroon L. Chughtai MD^d
• 刊名：The American Journal of Cardiology
• 出版年：2011
• 出版时间：1 March 2011
• 年：2011
• 卷：107
• 期：5
• 页码：774-777
• 全文大小：120 K

文摘

Prognosis of stable patients with acute pulmonary embolism (PE) has been assessed with cardiac troponin I (cTnI) and right ventricular (RV) function or size. Whether creatine kinase-MB isoenzyme (CK-MB) would add to the prognostic assessment is uncertain. We retrospectively assessed in-hospital mortality from PE in 392 stable patients to test the hypothesis that CK-MB would be of greater prognostic value than cTnI or RV size and we assessed whether combinations would increase prognostic value. CK-MB was high in 29 patients (7.4 % ); cTnI was high in 76 patients (19 % ) and intermediate in 78 patients (20 % ). The right ventricle was dilated in 128 patients (33 % ). Trends showed highest in-hospital mortality from PE in 4 of 29 (14 % ) with high CK-MB compared to 6 of 76 (7.9 % ) with high cTnI and 8 of 128 (6.3 % ) with RV dilatation (differences NS). High CK-MB and high cTnI provided added prognostic information only in patients with RV dilatation. Mortality with high CK-MB plus RV dilatation (4 of 19, 21 % ) tended to exceed mortality with high cTnI plus RV dilatation (5 of 39, 13 % , NS). When CK-MB and cTnI were high and the right ventricle was dilated, PE mortality tended to be highest (4 of 14, 29 % , NS). In conclusion, cardiac biomarkers contributed to prognosis only in patients with RV dilatation. CK-MB was the strongest predictor of death from PE but its prevalence was low, thus limiting its value as a single prognostic indicator. The combination of high CK-MB, high cTnI, and RV dilatation tended to indicate the highest mortality.