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Yasin Abul¹ , Sait Karakurt¹, Ahmet Toprak², Turgay Çelikel¹

RELATIONSHIP BETWEEN TROPONIN-T PRO-BNP,D-DIMER, CRP,ESR AND RIGHT VENTRICULAR DYSFUNCTION IN PATIENTS WITH PULMONARY EMBOLISM. Yasin Abul¹ , Sait Karakurt¹, Ahmet Toprak², Turgay Çelikel¹

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Yasin Abul¹ , Sait Karakurt¹, Ahmet Toprak², Turgay Çelikel¹

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  1. RELATIONSHIP BETWEEN TROPONIN-T PRO-BNP,D-DIMER, CRP,ESR AND RIGHT VENTRICULAR DYSFUNCTION IN PATIENTS WITH PULMONARY EMBOLISM Yasin Abul¹, Sait Karakurt¹, Ahmet Toprak², Turgay Çelikel¹ ¹Department of Pulmonary and Critical Care Medicine, Marmara University Faculty of Medicine, Istanbul, Turkey ² Department of Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey

  2. HYPOTHESIS Pulmonary Embolism (PE) Pulmonary Arterial Hypertension Ischemia Hypoxia Interaction between thrombus and endothelium RIGHT VENTRICULAR OVERLOAD Troponin-T ?, pro-BNP ? ? RIGHT VENTRICULAR DYSFUNCTION ? INFLAMATORY RESPONSE PROGNOSIS ESR ?, CRP ? Stenmark et al 1997;59:89 Annu.Rev. Physiol

  3. STUDY OBJECTIVES • Relationship between Troponın-Tpro-BNP,D-Dimer, CRP,ESR and right ventricular dysfunction in patients with pulmonary embolism was investigated.

  4. BNP Levin et al NEJM 1998;339: 321-328

  5. Pro-BNP BNP(Brain natiuretic peptide) is present in human brain, but there is considerably more in cardiac ventricles and is released from ventricles in response to strecth and increased pressure Pro-BNP BNP + NT-proBNP (108 aa) (32 aa)

  6. Troponin-T, ESR ve CRP • Troponin-T is released from damaged heart tissue and it is sensitive and spesific marker. • Troponin-T can increase in severe pulmonary embolism • ESR ve CRP are markers of inflammation

  7. METOT • Number of 39 patients with PE was taken into study • Number of 17 (10 of them w RVD) (F/M:8/9; 63±17y/ 64±11y) patient without left-sided heart failure was evaluated for pro-BNP and Troponin-T values

  8. METHODS • Clinical and laboratory findings with V/P sintigraphy and CT-angiography was used as dignostic methods • Serum of patients was taken in 12 hours of admission • Echocardiography for right ventricular dysfunction was performed to all patients in 24 hours of admission

  9. Right Ventricular Dysfunction Criteria(RVD) • Right ventrikular dilatation(diastolik diameter >30 mm) • Right ventr/leftventr. end diastolic diameter ratio>1 • Right ventrikular hyphokinesis • Tricuspid insufficiency(jet velocity>2.5 m/s) Presence of one of the above means RVD

  10. EXCLUSION CRITERIA 1- Patients with left ventricular heart failure 2- Patients with acute infection 3- Patients with Chronic inflamatory diseases 4- Patients under the age of 18

  11. BULGULAR • Right ventricular dysfunction(RVD) was found in 10 patients. • 7 patients had no RVD.

  12. p>0.05 6306 n=10 2312 n=7 RVD + RVD - RIGHT VENTRICULAR DYSFUNCTION N Value<500 pg/ml

  13. p>0.05 0.08 n=10 0.03 n=7 RVD + RVD - RIGHT VENTRICULAR DYSFUNCTION N Value<0.01 ng/ml

  14. p>0.05 68 n=18 46 n=12 RVD + RVD - RIGHT VENTRICULAR DYSFUNCTION 1 N Value <20 mm/sa

  15. p>0.05 77 n=18 46 n=12 RVD + RVD - N Value<8 mg/L RIGHT VENTRICULAR DYSFUNCTION

  16. p>0.05 2.32 n=10 1.72 n=7 RVD + RVD - RIGHT VENTRICULAR DYSFUNCTION N Value<0.5µ/ml

  17. LITERATURE • Level of BNP, NT-proBNP, pro-BNP and Troponin-T is related to the right ventricular dysfunction and prognosis of PE • As far as we know there si no study to show relationship between ESR, CRP and right ventricular dysfunction

  18. CONCLUSIONS • In conclusion, inflamatory markers including CRP and ESR in patient with PTE having RVD and cardiac markers including Troponin-T and pro-BNP in PTE patients with RVD show an increasing tendency compared to patients with PTE having no RVD.(non-significant) • Number of patients should be increased.

  19. THANK YOU

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