To evaluate the release of cardiac troponin I in normotensive patients with acute pulmonary embolism in relation to the duration of symptoms.
Fifty-seven normotensive patients with acute pulmonary embolism were included in the study. Patients were divided into two groups based on the duration of symptoms, group A with symptoms < 72 hours at presentation and group B with symptoms of > 72 hours. Cardiac troponin I levels were measured twice, at presentation and 8 hours later.
Among the study population, 33 patients (58%) had symptoms of > 72 hours (group A) and 24 patients (42%) had symptoms of > 72 hours (group B). There was no difference in the severity of pulmonary embolism between the two groups and both groups had similar prevalence of right ventricular dysfunction on echocardiography (55% in group A vs. 42% in group B, p=NS). Sixteen patients had elevated cardiac troponin I. All patients with elevated cardiac troponin I (n=16) were in group A. In group A, 67% (n=12) of patients with right ventricular dysfunction had elevated cardiac troponin I and 27% (n=4) of patients without right ventricular dysfunction had elevated cardiac troponin I. On subgroup analysis of patients with duration of symptoms < 72 hours at presentation, 81% of patients (n=13) with elevated cardiac troponin I had duration of symptoms < 24 hours at presentation. In patients presenting within 8 hours after symptom onset (n=7) the peak troponin I levels were found at presentation in 50% (n=4) of the patients, with the median time to peak levels being 8 hours after symptom onset.
The dynamics of cardiac troponin I in acute pulmonary embolism in patients who present with symptoms of < 72 hours duration are different from those who present with longer symptom duration.
The use of cardiac troponin I in risk stratification of acute pulmonary embolism may be limited to the patients presenting within 72 hours of the onset of symptoms.
Characteristics Based On The Duration Of SymptomsCharacteristicsSymptoms < 72 hours (n=33 patients)Symptoms > 72 hours (n=24 patients)P valueAge (years)63±1764±19NSMales42%(n=14)38%(n=9)NSModerate pulmonary embolism55%(n=18)42%(n=10)NSSmall pulmonary embolism45%(n=15)58%(n=14)NSElevated cardiac troponin I48%(n=16)None<0.0001Elevated cardiac troponin I with right ventricular dysfunction67%(n=12)None0.0005Elevated cardiac troponin I without right ventricular dysfunction27%(n=4)NoneNS
G. Punukollu, None.