High-sensitivity troponin I for risk stratification in normotensive pulmonary embolism
- Matthias Ebner1,2,
- Niklas Guddat3,
- Karsten Keller4,5,
- Marie Christine Merten3,
- Markus H. Lerchbaumer6,
- Gerd Hasenfuß3,7,
- Stavros V. Konstantinides4,8 and
- Mareike Lankeit2,3,4,9⇑
- 1Department of Cardiology and Angiology, Campus Charité Mitte (CCM), Charité – University Medicine Berlin, Berlin, Germany
- 2German Center for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany
- 3Clinic of Cardiology and Pneumology, University Medical Center Goettingen, Goettingen, Germany
- 4Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Johannes Gutenberg-University Mainz, Mainz, Germany
- 5Center for Cardiology, Cardiology I, University Medical Center Mainz, Johannes Gutenberg-University Mainz, Mainz, Germany
- 6Department of Radiology, Campus Charité Mitte (CCM), Charité – University Medicine Berlin, Berlin, Germany
- 7German Cardiovascular Research Centre (DZHK), partner site Goettingen, Goettingen, Germany
- 8Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece
- 9Department of Internal Medicine and Cardiology, Campus Virchow Klinikum (CVK), Charité – University Medicine Berlin, Berlin, Germany
- Dr Mareike Lankeit, Department of Internal Medicine and Cardiology, Campus Virchow Klinikum (CVK), Charité – University Medicine Berlin, Augustenburger Platz 1, 13353 Berlin, Germany. E-mail: mareike.lankeit{at}charite.de
Abstract
While numerous studies confirmed the prognostic role of high-sensitivity troponin T (hsTnT) in pulmonary embolism (PE), high-sensitivity troponin I (hsTnI) is inappropriately studied. This study aimed to investigate the prognostic relevance of hsTnI in normotensive PE, establish the optimal cut-off value for risk stratification and compare the prognostic performances of hsTnI and hsTnT.
Based on data from 459 consecutive PE patients enrolled in a single-centre registry, receiver operating characteristic analysis was used to identify an optimal hsTnI cut-off value for prediction of in-hospital adverse outcomes (PE-related death, cardiopulmonary resuscitation or vasopressor treatment) and all-cause mortality.
Patients who suffered an in-hospital adverse outcome (4.8%) had higher hsTnI concentrations compared to those with a favourable clinical course (57 [IQR 22–197] versus 15 [IQR 10–86] pg·mL−1, p=0.03). A hsTnI cut-off value of 16 ng·mL−1 provided optimal prognostic performance and predicted in-hospital adverse outcomes (Odds ratio [OR] 6.5, 95% confidence interval [CI] 1.9–22.4) and all-cause mortality (OR 3.7, 95% CI 1.0–13.3). Between female and male patients, no relevant differences in hsTnI concentrations (17 [IQR 10–97] versus 17 [IQR 10–92] pg·mL−1, p=0.79) or optimised cut-off values were observed. Risk stratification according to the 2019 European Society of Cardiology algorithm revealed no differences if calculated based on either hsTnI or hsTnT (p=0.68).
Our findings confirm the prognostic role of hsTnI in normotensive PE. HsTnI concentrations >16 pg·mL−1 predicted in-hospital adverse outcome and all-cause mortality; sex-specific cut-off values do not appear necessary. Importantly, our results suggest that hsTnI and hsTnT can be used interchangeably for risk stratification.
Footnotes
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Conflict of interest: Dr. Ebner has nothing to disclose.
Conflict of interest: Dr. Guddat has nothing to disclose.
Conflict of interest: Dr. Keller has nothing to disclose.
Conflict of interest: Dr. Merten has nothing to disclose.
Conflict of interest: Dr. Lerchbaumer reports personal fees from Siemens Healthineers, outside the submitted work.
Conflict of interest: Dr. Hasenfuß reports personal fees from AstraZeneca, personal fees from Berlin Chemie, personal fees from Corvia, personal fees from Impulse Dynamics, personal fees from Novartis, personal fees from Servier, personal fees from Vifor Pharma, personal fees from Springer International Publishing AG, outside the submitted work.
Conflict of interest: Dr. Konstantinides reports grants from German Federal Ministry of Education and Research (BMBF 01EO1503), during the conduct of the study; grants and personal fees from Bayer, grants and personal fees from Boehringer Ingelheim, grants and personal fees from Daiichi-Sankyo, personal fees from MSD, grants and personal fees from Pfizer – Bristol-Myers Squibb, grants from Actelion, outside the submitted work.
Conflict of interest: Dr. Lankeit reports grants from German Federal Ministry of Education and Research (BMBF 01EO1503), grants from BRAHMS GmbH, part of Thermo Fisher Scientific, during the conduct of the study; personal fees from Actelion, personal fees from Bayer, personal fees from Daiichi-Sankyo, personal fees from MSD, personal fees from Pfizer – Bristol-Myers Squibb, personal fees from BRAHMS GmbH, part of Thermo Fisher Scientific, outside the submitted work.
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- Received August 28, 2020.
- Accepted October 5, 2020.
- Copyright ©ERS 2020
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