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Right ventricular (RV) dysfunction with myocardial damage may lead to fatal complications in patients with acute pulmonary embolism (PE). Cytoplasmic heart-type fatty acid binding protein (H-FABP) and N-terminal fragment of its prohormone (NTproBNP) are sensitive and specific biomarkers of myocardial damage. We evaluated RV dysfunction and cardiac biomarkers for myocardial damage and short-term risk stratification in patients with acute PE.
We analyzed 41 patients (24 female, 17 male) with confirmed acute PE. Three groups (massive, submassive and non-massive) of patients were defined, based on systemic systolic blood pressure measured on admission and the RV dysfunction by transthoracic echocardiography (TTE). Also, systolic (s) and mean (m) pulmonary artery pressures (PAP) were recorded by TTE, and plasma concentrations of cardiac troponin T (cTnT), myoglobin (Mb), NT-proBNP, and H-FABP were analyzed.
Twelve (29,3%) patients died (3 PE related deaths) and 17 (41,5%) experienced complicated clinical course- in 6 month follow-up- the combined end-point including at least one of the following: death, chronic PE, pulmonary hypertension and recurrent PE. Hazard ratio analysis demonstrated that PAPs, PAPm, plasma H-FABP, NT-proBNP, cTnT and Mb concentrations predicted fatal outcome. When only PE-related deaths were considered, PAPs, plasma H-FABP and NT-proBNP concentrations indicated fatal outcome. Multivariate hazard ratio analysis revealed H-FABP, NT-proBNP and PAPs as the only 6-month mortality predictor. (HR 1.02 CI 95% 1.01–1.05, 1.01 CI 95% 1.01–1.04 and 1.02 CI 95% 1.02–1.05 respectively).
H-FABP, NT-proBNP and PAPs measured on admission are useful for short-term risk stratification and in the prediction of 6-month PE-related mortality in patients with acute PE.