MedWire News: Highly sensitive troponin T (hsTnT) assays improve the risk stratification of patients with acute pulmonary embolism (PE) by ruling out an adverse early outcome, German researchers report.
"The strategies for prognostic assessment of patients with acute PE who are hemodynamically stable on admission remain controversial," say Mareike Lankeit (University of Göttingen) and colleagues.
To assess the prognostic value of baseline cardiac troponin T (cTnT) levels measured by a hsTnT assay, Lankeit and team prospectively studied 156 consecutive normotensive patients with acute PE confirmed by imaging.
They compared the results of the hsTnT assay with the conventional cTnT assay and with N-terminal pro-brain natriuretic peptide (NT-proBNP) concentrations.
The researchers report that 100 (64%) patients had hsTnT levels at or above the cut-off value of 14 pg/ml. By comparison, 52 (33.3%) patients had elevated cTnT levels above the cut-off value of 0.03 ng/ml when using the conventional assay.
Baseline hsTnT was significantly higher in patients with an adverse 30-day outcome (death, or a need for catecholamines, endotracheal intubation, or cardiopulmonary resuscitation), at 71.7 pg/ml, compared with 26.4 pg/ml among those that had an uncomplicated course.
The hsTnT assay had 100% sensitivity and a negative predictive value that was also 100%, suggesting that a negative hsTnT test on admission would rule out an adverse early outcome of acute PE. In contrast, 50% of the patients with an adverse early outcome would have been misclassified as low risk by the conventional cTnT assay.
During a median follow-up of 32 months, 22 (14.4%) patients died. Patients with elevated hsTnT levels had a significantly reduced probability of long-term survival, compared with patients with normal TnT levels. Conversely, elevated cTnT measured on the conventional assay and NT-proBNP concentrations were not significantly associated with a poor long-term prognosis.
"Our findings indicate that the [hsTnT] assay may help identify low-risk patients and thus possible candidates for home treatment; patients with an elevated risk for an adverse early outcome, particularly when used in combination with echocardiography; and patients who may need closer long-term follow-up because of an increased risk of late mortality," conclude Lankeit and co-authors in the European Heart Journal.
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