TY - JOUR
T1 - Pulmonary embolism
T2 - CT signs and cardiac biomarkers for predicting right ventricular dysfunction
AU - Henzler, T.
AU - Roeger, S.
AU - Meyer, M.
AU - Schoepf, U. J.
AU - Nance, J. W.
AU - Haghi, D.
AU - Kaminski, W. E.
AU - Neumaier, M.
AU - Schoenberg, S. O.
AU - Fink, C.
PY - 2012/4/1
Y1 - 2012/4/1
N2 - The aim of this study was to prospectively evaluate the accuracy of quantitative cardiac computed tomography (CT) parameters and two cardiac biomarkers (N-terminal-pro-brain natriuretic peptide (NT-pro-BNP) and troponin I), alone and in combination, for predicting right ventricular dysfunction (RVD) in patients with acute pulmonary embolism. 557 consecutive patients with suspected pulmonary embolism underwent pulmonary CT angiography. Patients with pulmonary embolism also underwent echocardiography and NT-pro-BNP/troponin I serum level measurements. Three different CT measurements were obtained (right ventricular (RV)/left ventricular (LV)axial, RV/LV4-CH and RV/LVvolume). CT measurements and NT-pro-BNP/troponin I serum levels were correlated with RVD at echocardiography. 77 patients with RVD showed significantly higher RV/LV ratios and NT-pro-BNP/troponin I levels compared to those without RVD (RV/LVaxial 1.68±0.84 versus 1.00±0.21; RV/LV4-CH 1.52±0.45 versus 1.01±0.21; RV/LVvolume 1.97±0.53 versus 1.07±0.52; serum NT-pro-BNP 6,372±2,319 versus 1,032±1,559 ng·L-1; troponin I 0.18±0.41 versus 0.06±0.18 g·L-1). The area under the curve for the detection of RVD of RV/LVaxial, RV/LV4-CH, RV/LVvolume, NT-pro-BNP and troponin I were 0.84, 0.87, 0.93, 0.83 and 0.70 respectively. The combination of biomarkers and RV/LVvolume increased the AUC to 0.95 (RV/LVvolume with NT-pro-BNP) and 0.93 (RV/LVvolume with troponin I). RV/LVvolume is the most accurate CT parameter for identifying patients with RVD. A combination of RV/LVvolume with NT-pro-BNP or troponin I measurements improves the diagnostic accuracy of either test alone. Copyright
AB - The aim of this study was to prospectively evaluate the accuracy of quantitative cardiac computed tomography (CT) parameters and two cardiac biomarkers (N-terminal-pro-brain natriuretic peptide (NT-pro-BNP) and troponin I), alone and in combination, for predicting right ventricular dysfunction (RVD) in patients with acute pulmonary embolism. 557 consecutive patients with suspected pulmonary embolism underwent pulmonary CT angiography. Patients with pulmonary embolism also underwent echocardiography and NT-pro-BNP/troponin I serum level measurements. Three different CT measurements were obtained (right ventricular (RV)/left ventricular (LV)axial, RV/LV4-CH and RV/LVvolume). CT measurements and NT-pro-BNP/troponin I serum levels were correlated with RVD at echocardiography. 77 patients with RVD showed significantly higher RV/LV ratios and NT-pro-BNP/troponin I levels compared to those without RVD (RV/LVaxial 1.68±0.84 versus 1.00±0.21; RV/LV4-CH 1.52±0.45 versus 1.01±0.21; RV/LVvolume 1.97±0.53 versus 1.07±0.52; serum NT-pro-BNP 6,372±2,319 versus 1,032±1,559 ng·L-1; troponin I 0.18±0.41 versus 0.06±0.18 g·L-1). The area under the curve for the detection of RVD of RV/LVaxial, RV/LV4-CH, RV/LVvolume, NT-pro-BNP and troponin I were 0.84, 0.87, 0.93, 0.83 and 0.70 respectively. The combination of biomarkers and RV/LVvolume increased the AUC to 0.95 (RV/LVvolume with NT-pro-BNP) and 0.93 (RV/LVvolume with troponin I). RV/LVvolume is the most accurate CT parameter for identifying patients with RVD. A combination of RV/LVvolume with NT-pro-BNP or troponin I measurements improves the diagnostic accuracy of either test alone. Copyright
KW - Cardiopulmonary inter-relationships
KW - Cardiopulmonary testing
KW - Cardiovascular
KW - Computed tomography
KW - Critical care medicine
KW - Pulmonary circulation
UR - http://www.scopus.com/inward/record.url?scp=84860326197&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84860326197&partnerID=8YFLogxK
U2 - 10.1183/09031936.00088711
DO - 10.1183/09031936.00088711
M3 - Article
C2 - 21965223
AN - SCOPUS:84860326197
VL - 39
SP - 919
EP - 926
JO - European Respiratory Journal
JF - European Respiratory Journal
SN - 0903-1936
IS - 4
ER -