Internal and Emergency Medicine

, Volume 3, Issue 2, pp 131–138 | Cite as

Troponin I and right ventricular dysfunction for risk assessment in patients with nonmassive pulmonary embolism in the Emergency Department in combination with clinically based risk score

  • Vittorio PalmieriEmail author
  • Giovanni Gallotta
  • Domenico Rendina
  • Silvana De Bonis
  • Vittorio Russo
  • Alfredo Postiglione
  • Stefania Martino
  • Matteo Nicola Dario Di Minno
  • Aldo Celentano
EM - Original


To determine whether troponin I (cTnI) and right ventricular (RV) dysfunction predict adverse in-hospital outcomes in patients admitted to the Emergency Department (ED) with definite nonmassive pulmonary embolism (PE) independent of and in addition to a recently validated clinical prognostic risk score. From a pool of 168 patients with suspected PE, 89 had nonmassive PE confirmed by spiral lung angio-computed tomography. By the clinical prognostic score, in our study sample, 14% had very low risk; 17% had low risk, 20% had intermediate risk, whereas high risk and very high risk were identified in 29 and 20%, respectively. Prevalence of elevated cTnI (>0.1 μg/L, 57%) at admission was comparable among patients grouped by clinical prognostic score (P = NS); echocardiographic RV dysfunction (54%) was more prevalent with intermediate or high clinical risk score (P < 0.02). Increased cTnI predicted primary end-point (development of hemodynamic instability, overall 33 cases, 37%) independent of and in addition to the clinical risk class and RV dysfunction (P < 0.01 for interaction). Fatal events (12 cases, 14%, 5 definite, 7 possible PE-related) were predicted by higher clinical risk score (P < 0.05). In patients with nonmassive central PE admitted to the ED, increased cTnI contributed to identifying those with increased risk of development of hemodynamic instability independent of and in addition to a validated clinically based risk score.


Pulmonary embolism Troponin Prognosis Echocardiography 


Conflict of interest

No author has conflict of interest to disclose.


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Copyright information

© SIMI 2008

Authors and Affiliations

  • Vittorio Palmieri
    • 1
    • 2
    Email author
  • Giovanni Gallotta
    • 2
  • Domenico Rendina
    • 3
  • Silvana De Bonis
    • 3
  • Vittorio Russo
    • 3
  • Alfredo Postiglione
    • 2
  • Stefania Martino
    • 2
  • Matteo Nicola Dario Di Minno
    • 2
  • Aldo Celentano
    • 1
    • 2
  1. 1.Cardiology Unit“Ospedale dei Pellegrini”NaplesItaly
  2. 2.Department of Clinical and Experimental Medicine“Federico II” University Hospital, University of Naples-School of MedicineNaplesItaly
  3. 3.Department of Emergency Medicine“Antonio Cardarelli” HospitalNaplesItaly

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