engleski

Timing of troponin T measurements in triage of pulmonary embolism patients

Aim: Despite having good prognostic value, data on the appropriate timing for troponin measurement in pulmonary embolism (PE) patients is still uncertain. It is not clear whether the initial measurement of cardiac troponin is enough for early clinical triage and the need for ICU admission. Thus, the aim of the present study was to investigate the appropriate timing of cardiac troponin T (cTnT) measurement for the early triage of PE patients. Methods: This was a single-centre prospective study. PE was confirmed in all patients using computed tomography. Patients were divided into three groups (high-risk, intermediate, and low- risk) based on their hemodynamic status and echocardiographic signs of right ventricular dysfunction. Troponin T (cTnT) levels were measured on admission and then after 6, 24, 48 and 72 h with threshold values greater than 0.1 ng/mL. Results: The population of study included 104 consecutive patients. Unlike high- risk patients, increased cTnT levels were noted in intermediate-risk PE patients in the first measurement (P=0.037). Elevated cTnT levels significantly correlated with disease severity in both groups after 6 h (high-risk, P=0.016, intermediate-risk, P=0.009). This correlation was not observed in subsequent controls in both groups of patients. Conclusion: The present study shows that, when assessing PE patients in the emergency department, two consecutive assessments of cTnT at an interval of 6 h allows for the identification of PE patients who require ICU admission and aggressive treatment. In hemodynamically stable patients, increased cTnT level on admission differentiates intermediate from low-risk patients without the need for further cTnT measurement.

pulmonary embolism; right ventricular dysfunction; cardiac troponine T

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