Interv Akut Kardiol. 2011;10(3):102-108

Biomarkers in acute pulmonary embolism

Jiří Widimský

Klinika kardiologie, IKEM, Praha

Biomarkers may significantly improve the quantification of risk in normotensive patients with acute pulmonary embolism. Biomarkers

are divided into 1) troponins, 2) natriuretic peptides, and 3) new biomarkers. A meta-analysis including 20 studies published since

1998 and comprising 1,985 patients with acute pulmonary embolism showed that elevated troponins are linked with an increased risk

of death and an increased risk of major complications. Another meta-analysis including 1,366 only normotensive patients with acute

pulmonary embolism from 9 studies, however, showed that increased troponins in normotensive patients fail to identify patients with

a poor prognosis. An increase in troponins in normotensive patients with acute pulmonary embolism seems not to be sufficient for

stratification and will not, by itself, identify patients requiring aggressive treatment. In addition, no borderline levels for troponin T

and, particularly, troponin I have been established due to the heterogeneity of the methods used. Natriuretic peptides are a very sensitive

indicator of neurohumoral activation induced by ventricular dysfunction. A recent meta-analysis of 13 studies found an increased

BNP or NT-proBNP in 51 % of 1,132 patients with acute pulmonary embolism. The increase was accompanied by an increased risk of

early death and complicated hospital course. However, an increase in natriuretic peptides by itself does not warrant the initiation of

invasive treatment including thrombolysis. Normal levels of BNP and NT-proBNP do not rule out severe acute pulmonary embolism.

Echocardiography still remains the gold standard for detecting right ventricular dysfunction in patients with acute pulmonary embolism.

The new biomarkers include a) heart-type fatty acid binding protein (H-FABP), b) growth differentiation factor 15 (GDF-15), and

c) highly sensitive troponin T (hsTnT). The new biomarkers are characterized by a better positive and negative predictive value than the

previous biomarkers, i. e. troponins and NT-proBNP. This is particularly true for hsTnT and H-FABP. An increased level of H-FABP (6 ng/ml

and higher) was associated with a 36.6-fold increase in the risk of death or complications. Currently, the combination of right ventricular

dysfunction on echocardiography and increased highly sensitive troponin T appears to be the best parameter to identify normotensive

patients with acute pulmonary embolism in whom the use of thrombolytic treatment needs to be considered. However, larger studies

are required to prove whether hsTnT is a better predictor than the other new biomarkers.

acute pulmonary embolism.

Keywords: highly sensitive troponin T, heart-type fatty acid binding protein, growth differentiation factor 15, prognosis of normotensive

Published: June 10, 2011  Show citation