PURPOSE: The objective of this study was to evaluate the clinical usefulness of serum troponin I in the assessment of acute pulmonary embolism (PE) and right ventricular (RV) dysfunction on echocardiogram (ECHO).
METHODS: We reviewed the records of 40 patients with the clinical diagnosis of acute PE. Patients with prior history of end stage renal disease, chronic pulmonary hypertension (PHTN) and concomitant MI at the time of presentation were excluded from the study. 12 patients had actual PE confirmed by spiral CT or high probability ventilation-perfusion (V/Q) lung scans. ECHO was performed on all patients. We considered the highest serum troponin I value from the admission to 48 hours and a normal cutoff value of <0.04 ng/ml.
RESULTS: Mean age of the patients were 56.3 years, out of 12 patients with confirmed Dx of acute PE, 8 (66%) were females and 4 (34%) were males. 9 (75%) of these patients were presented with shortness of breath and 3 (25%) had pleuritic chest pain on admission. A total of 11 (91.6%) of 12 patients had elevated serum troponin I levels. On ECHO 4 (34%) patients had acute PHTN, among these 3 (25%) of them had moderate to severe RV dilatation and serum troponin I level of 0.5, 0.43 and 0.21 respectively. Overall, mean and highest serum troponin I levels were 0.22 and 0.56 ng/dl respectively.
CONCLUSION: Our data demonstrate that almost all (11 out of 12) patients with high probability V/Q scans or positive spiral CT had elevated serum troponin I levels which were independent of ECHO findings or the extension of PE as expressed by segmental, lobar or entire lung perfusion defect. Although the serum troponin I levels were high, the highest recorded level was < 0.6 ng/dl.
CLINICAL IMPLICATIONS: Pulmonary embolism should be considered in the differential diagnosis of chest pain with an elevated serum troponin I level.
DISCLOSURE: Arshad Ali, No Financial Disclosure Information; No Product/Research Disclosure Information