The relationship between pulmonary artery obstruction index and troponin in thorax computed tomography in pulmonary embolism

Year 2022, Volume: 5 Issue: 5, 1361 - 1365, 25.09.2022

Ercan Çil Mahmut Çoraplı Gülistan Karadeniz Gökhan Çoraplı Tuğçe Başbuğ Baltalı

https://doi.org/10.32322/jhsm.1127534

Abstract

Aim: To study the relation between troponin and pulmonary artery obstruction index in thoracic computerized tomography in patients diagnosed with acute pulmonary embolism.
Material and Method: Data obtained from patients hospitalized in the ward and intensive care units with a pulmonary embolism diagnosis between January 2016 and February 2022 were scanned retrospectively. The full blood count, D-dimer, C-reactive protein, procalcitonin, troponin I, thoracic computerized tomography (CT), angiography, and bilateral lower extremity venous Doppler ultrasonography data were extracted. Patients with left heart failure, renal failure, gastrointestinal hemorrhage, sepsis, respiratory system disease, burns, ischemic stroke, or subarachnoid hemorrhage were excluded. The obstruction indices were calculated according to storage defects in the main, right, left, lobar, and segmental pulmonary artery branches in CT angiography.
Results: While 57.0% of the 69 patients included in the study were female, 42.1% were male. The obstruction index in the high troponin-I group was significantly higher than that in the normal troponin-I group (p=0.006). In addition, the obstruction index was significantly higher in patients with bilateral pulmonary embolism than in those with unilateral pulmonary embolism (<0.001). While there was a positive correlation between obstruction index and D-dimer (r=0.310 p=0.041), a significant negative correlation was found with the CRP value (r=-0.268 p=0.042). When the clinical and laboratory data of the patients with normal and high level troponin were examined, the ratios of patients in the ICU and with bilateral embolism were significantly higher in the high troponin group and the CRP value was significantly lower (p=0.004, 0.027, 0.003, respectively).
Conclusion: The pulmonary artery obstruction index shows thrombus load and is a parameter related to troponin.

Keywords

Pulmonary embolism, obstruction index, troponin I

Supporting Institution

yok

Project Number

yok

Thanks

-

References

• Arseven O, Okumuş N.G, Öngen G, Müsellim B. Pulmoner Tromboembolizm tanı ve tedavi uzlaşı raporu. Türk Toraks Derneği 2015: 1-3
• Büber A, Altunrende Ş.S, Canan A. The relationship of pulmonary artery computed tomography obstruction index ratio, D-dimer and mean platelet volume levels in pulmonary embolism. Turkiye Klinikleri Arch Lung 2017; 18: 1-9
• Pruszczyk P, Bochowicz A, Torbicki A, et al. Cardiac troponin T monitoring identifies high-risk group of normotensive patients with acute pulmonary embolism. Chest 2003; 123: 1947-52.
• Becattini C, Vedovati MC, Agnelli G. Prognostic value of troponins in acute pulmonary embolism: a meta-analysis. Circulation 2007; 116: 427-33.
• Alshumrani G, Al Bshabshe A, Mousa WF. Diagnostic yield of CT pulmonary angiography for pulmonary embolism in clinically suspected patients. Medicine (Baltimore) 2021; 100: 26213.
• Qanadli SD, El Hajjam M, Vieillard-Baron A, et al. New CT index to quantify arterial obstruction in pulmonary embolism: comparison with angiographic index and echocardiography. AJR Am J Roentgenol 2001; 176: 1415-20.
• Shokoohi H, Shesser R, Smith JP Hill MC, Hirsch R. The correlation between elevated cardiac troponin I and pulmonary artery obstruction index in ED patients with pulmonary embolism. Am J Emerg Med 2009; 27: 449-53.
• Gul EE, Can I, Guler I, et al. Association of pulmonary artery obstruction index with elevated heart-type fatty acid binding protein and short-term mortality in patients with pulmonary embolism at intermediate risk. Diagn Interv Radiol 2012; 18: 531-6.
• Langroudi TF, Shabestari AA, Hekmati S, Pourghorban R. Association between pulmonary arterial obstruction index and right lateral ventricular wall thickness with in-hospital mortality in patients with acute pulmonary embolism. Emerg Radiol 2021; 28: 327-31.
• Apfaltrer P, Henzler T, Meyer M, et al. Correlation of CT angiographic pulmonary artery obstruction scores with right ventricular dysfunction and clinical outcome in patients with acute pulmonary embolism. Eur J Radiol 2012: 81: 2867-71.
• Büyükşirin M, Anar C, Polat G, Karadeniz G. Can the Level of CRP in Acute Pulmonary Embolism Determine Early Mortality?. Turk Thorac J 2021; 22: 4-10.
• Chauin A. The main causes and mechanisms of increase in cardiac troponin concentrations other than acute myocardial infarction (part 1): physical exertion, inflammatory heart disease, pulmonary embolism, renal failure, sepsis. Vasc Health Risk Manag 2021: 17: 601–17.
• Soares TH, de Bastos M, de Carvalho BV, et al. Prognostic value of computed tomographic pulmonary angiography and the pulmonary embolism severity index in patients with acute pulmonary embolism. Blood Coagul Fibrinolysis 2013: 24: 64-70.