Early and late adverse outcomes can be seen in patients with pulmonary embolism (PE). This study was designed to find out the importance of blood proBNP and troponin T values, tricuspid annular plane systolic excursion (TAPSE) and pulmonary artery pressure (PAP) received from echocardiography, right ventricle/left ventricle ratio (RV/LV) obtained from pulmonary CT angiography for early prognosis. Moreover, we also aimed to find out the role of these parameters to predict permanent high PAP which is known as chronic thromboembolic pulmonary hypertension (CTEPH).
80 patients with PE were enrolled the study. All patients' proBNP, troponin T values and RV/LV ratio were noted. Also, PAP and TAPSE values were recorded at admission and after 3 months of anticoagulant therapy.
In the whole group there were positive correlations between serum biomarkers, PAP value and RV/LV ratio, where there were negative correlations with TAPSE value at admission. Eleven patients had early adverse clinicaloutcome. With a threshold of 148 pg/ml, proBNP had a sensitivity of 81,8% and specifity of 52,3% for predicting early advers outcomes. PAP>35 mmHg at admission was significant predictor of early adverse outcomes. Eleven patients had elevated PAP (≥35 mmHg) after three months of anticoagulation. These patients had higher PAP, RV/LV ratio and proBNP levels at admission than the others. Furthermore, a PAB value of ≥41 mmHg at admission was found to be an independent risk factor for predicting CTEPH (OR=7.37, p=0.038).
PE patients with high cardiac biomarkers and RV/LV ratio should be monitored closely in early period of the disease whereas patients who have PAP ≥41 mmHg should be followed up carefully for the risk of CTEPH.