Karsten Keller1, Johannes Beule2, Andreas Schulz3, Meike Coldewey4, Wolfgang Dippold2, Jörn Oliver Balzer5. 1. Department of Medicine II, University Medical Center Mainz, Johannes Gutenberg-University Mainz; Center for Thrombosis and Haemostasis, University Medical Center Mainz, Johannes Gutenberg-University Mainz. Electronic address: Karsten.Keller@unimedizin-mainz.de. 2. Department of Internal Medicine, St. Vincenz and Elisabeth Hospital Mainz (KKM). 3. Department of Medicine II, University Medical Center Mainz, Johannes Gutenberg-University Mainz. 4. Department of Medicine II, University Medical Center Mainz, Johannes Gutenberg-University Mainz; Center for Thrombosis and Haemostasis, University Medical Center Mainz, Johannes Gutenberg-University Mainz. 5. Department of Radiology and Nuclear Medicine, Catholic Clinic Mainz (KKM); Department of Diagnostic and Interventional Radiology, University Clinic, Johann Wolfgang Goethe-University Frankfurt/Main.
Abstract
BACKGROUND: Echocardiography for risk stratification in hemodynamically stable patients with pulmonary embolism (PE) is well-established. Right ventricular dysfunction (RVD) is associated with an elevated mortality and adverse outcome. The aim of our study was to compare RVD criteria and investigate the role of elevated systolic pulmonary artery pressure (sPAP) in the diagnosis of RVD. METHODS: We retrospectively analyzed the echocardiographic and laboratory data of all hemodynamically stable patients with confirmed PE (2006-2011). The data were compared with three different definitions of RVD: Definition 1: RV dilatation, abnormal motion of interventricular septum, RV hypokinesis or tricuspid regurgitation. Definition 2: as with definition 1 but including elevated sPAP (>30mmHg). Definition 3: elevated sPAP (>30mmHg) as single RVD criterion. RESULTS: A total number of 129 patients (59.7% women, age 70.0years (60.7/81.0)) were included in this study. Median Troponin I level was measured as 0.02ng/ml (0/0.14); mean sPAP 33.9±18.5mmHg. The troponin cut-off levels for predicting a RVD of the 3 RVD definitions were in definition 1-3: >0.01ng/ml, >0.01ng/ml and >0.00ng/ml. Analysis of the ROC curve showed an AUC for RVD definitions 1-3: 0.790, 0.796 and 0.635. CONCLUSIONS: The combination of commonly used RVD criteria with added elevated sPAP improves the diagnosis of RVD in acute PE. Troponin I values of >0.01ng/ml in acute PE point to an RVD.
BACKGROUND: Echocardiography for risk stratification in hemodynamically stable patients with pulmonary embolism (PE) is well-established. Right ventricular dysfunction (RVD) is associated with an elevated mortality and adverse outcome. The aim of our study was to compare RVD criteria and investigate the role of elevated systolic pulmonary artery pressure (sPAP) in the diagnosis of RVD. METHODS: We retrospectively analyzed the echocardiographic and laboratory data of all hemodynamically stable patients with confirmed PE (2006-2011). The data were compared with three different definitions of RVD: Definition 1: RV dilatation, abnormal motion of interventricular septum, RV hypokinesis or tricuspid regurgitation. Definition 2: as with definition 1 but including elevated sPAP (>30mmHg). Definition 3: elevated sPAP (>30mmHg) as single RVD criterion. RESULTS: A total number of 129 patients (59.7% women, age 70.0years (60.7/81.0)) were included in this study. Median Troponin I level was measured as 0.02ng/ml (0/0.14); mean sPAP 33.9±18.5mmHg. The troponin cut-off levels for predicting a RVD of the 3 RVD definitions were in definition 1-3: >0.01ng/ml, >0.01ng/ml and >0.00ng/ml. Analysis of the ROC curve showed an AUC for RVD definitions 1-3: 0.790, 0.796 and 0.635. CONCLUSIONS: The combination of commonly used RVD criteria with added elevated sPAP improves the diagnosis of RVD in acute PE. Troponin I values of >0.01ng/ml in acute PE point to an RVD.
Authors: Thomas Münzel; Philipp S Wild; Karsten Keller; Christoph Sinning; Andreas Schulz; Claus Jünger; Volker H Schmitt; Omar Hahad; Tanja Zeller; Manfred Beutel; Norbert Pfeiffer; Konstantin Strauch; Stefan Blankenberg; Karl J Lackner; Jürgen H Prochaska; Eberhard Schulz Journal: Sci Rep Date: 2021-11-18 Impact factor: 4.379
Authors: Karsten Keller; Martin Geyer; Johannes Beule; Meike Coldewey; Jörn Oliver Balzer; Wolfgang Dippold Journal: Thorac Cancer Date: 2015-01-22 Impact factor: 3.500