Key result
High cTnI and high CK-MB with normal right ventricular size occurred in only 1.9% of stable patients with acute pulmonary embolism, making the diagnosis unlikely.
Why the study?
Does the combination of elevated cardiac biomarkers and normal right ventricular size make the diagnosis of acute pulmonary embolism unlikely in stable patients?
Observational (n=585)
Does the combination of elevated cardiac biomarkers and normal right ventricular size make the diagnosis of acute pulmonary embolism unlikely in stable patients?
The combination of elevated cardiac biomarkers and normal RV size is rare in stable acute PE, suggesting alternative diagnoses like acute coronary syndrome should be prioritized.
May favor alternative diagnoses like ACS in stable patients with elevated biomarkers and normal RV; leaves open prospective validation of this pattern.
The purpose of this investigation is to assess the prevalence of elevated cardiac biomarkers, with or without estimates of right ventricular (RV) size, in stable patients with acute pulmonary embolism (PE). Our hypothesis is that the combination of high levels of cardiac troponin I (cTnI), high creatine kinase isoenzyme MB (CK-MB), and normal size RV are sufficiently uncommon in stable patients with PE to make the diagnosis of PE unlikely. Retrospective review showed a high cTnI plus high CK-MB in 20 (3.4%) of 585 stable patients with acute PE. A high cTnI plus high CK-MB with normal RV size was shown in 5 (1.9%) of 264 patients. In stable patients with such findings, therefore, PE is unlikely and other diagnoses, particularly acute coronary syndrome, should be considered before pursuing a diagnosis of PE.
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Stein et al. (2011) conducted an observational in acute pulmonary embolism (n=585). Elevated cardiac biomarkers (cTnI and CK-MB) with normal right ventricular size was evaluated on Prevalence of high cTnI plus high CK-MB with normal RV size. High cTnI and high CK-MB with normal right ventricular size occurred in only 1.9% of stable patients with acute pulmonary embolism, making the diagnosis unlikely.
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