URG-L: Embolie pulmonaire

[J Levasseur]

Vous avez remarqu� que parfois les troponines sont �lev�es dans l’embolie pulmonaire??   Pourrait peut-�tre �tre utile pour la stratification de ces patients et pour guider l’agressivit� de nos traitements??   Voir l’abstract ci-joint :     (Circulation. 2002;106:1263.) � 2002 American Heart Association, Inc. Clinical Investigation and Reports Importance of Cardiac Troponins I and T in Risk Stratification of Patients With Acute Pulmonary Embolism Stavros Konstantinides, MD; Annette Geibel, MD; Manfred Olschewski, PhD; Wolfgang Kasper, MD; Nadine Hruska, MD; Sebastian J�ckle, MD; Lutz Binder, MD From Georg-August-Universit�t G�ttingen, Abteilung Kardiologie und Pneumologie (S.K., N.H.); Albert-Ludwigs-Universit�t Freiburg, Abteilung Kardiologie und Angiologie (A.G., S.J.); Albert-Ludwigs-Universit�t Freiburg, Abteilung Medizinische Biometrie und Informatik (M.O.); St Josefs Hospital Wiesbaden, Innere Abteilung (W.K.); and Georg-August-Universit�t G�ttingen, Abteilung Klinische Chemie (L.B.), Germany. Correspondence to Stavros Konstantinides, MD, Department of Cardiology and Pulmonary Medicine, Georg August University of Goettingen, Robert Koch Strasse 40, D-37075 Goettingen, Germany. E-mail [EMAIL PROTECTED] Background— Assessment of risk and appropriate management of patients with acute pulmonary embolism (PE) remains a challenge. Cardiac troponins I (cTnI) and T (cTnT) are reliable indicators of myocardial injury and may be associated with right ventricular dysfunction in PE. Methods and Results— The present prospective study included 106 consecutive patients with confirmed acute PE. cTnI was elevated (0.07 ng/mL) in 43 patients (41%), and cTnT (0.04 ng/mL) was elevated in 39 (37%). Elevation of cTnI or cTnT was significantly associated with echocardiographically detected right ventricular dysfunction (P=0.001 and P<0.05, respectively). Moreover, a significant correlation was found between elevation of cTnI or cTnT and the two major end points overall mortality and complicated in-hospital course. The negative predictive value of cardiac troponins for major clinical events was 92% to 93%. Importantly, there was obvious escalation of in-hospital mortality, the rate of complications, and the incidence of recurrent PE, when patients with high troponin concentrations (cTnI >1.5; cTnT >0.1 ng/mL) were compared with those with only moderately elevated levels (cTnI, 0.07 to 1.5; cTnT, 0.04 to 0.1 ng/mL). Logistic regression analysis confirmed that the mortality risk (OR) was significantly elevated only in patients with high cTnI (P=0.019) or cTnT (P=0.038) levels. Furthermore, the risk of a complicated in-hospital course was almost 5 times higher (15.47 versus 3.16) in the high-cTnI group compared with patients with moderate cTnI elevation. Conclusions— Our results indicate that cTnI and cTnT may be a novel, particularly useful tool for optimizing the management strategy in patients with acute PE. J. Levasseur