Use of biomarkers or echocardiography in pulmonary embolism: the Swiss Venous Thromboembolism Registry.

Abstract

BACKGROUND:

Cardiac biomarkers and echocardiography for assessing right ventricular function are recommended to risk stratify patients with acute non-massive pulmonary embolism (PE), but it remains unclear if these tests are performed systematically in daily practice.

DESIGN AND METHODS:

Overall, 587 patients with acute non-massive PE from 18 hospitals were enrolled in the Swiss Venous Thromboembolism Registry (SWIVTER): 178 (30%) neither had a biomarker test nor an echocardiographic evaluation, 196 (34%) had a biomarker test only, 47 (8%) had an echocardiogram only and 166 (28%) had both tests.

RESULTS:

Among the 409 (70%) patients with biomarkers or echocardiography, 210 (51%) had at least one positive test and 67 (16%) had positive biomarkers and right ventricular dysfunction. The ICU admission rates were 5.1% without vs. 5.6% with testing (P = 0.78), and thrombolysis or embolectomy were performed in 2.8% vs. 4.9%, respectively (P = 0.25). In multivariate analysis, syncope [odds ratio (OR): 3.49, 95% confidence interval (CI): 1.20-10.15; P = 0.022], tachycardia (OR: 2.31, 95% CI: 1.37-3.91; P = 0.002) and increasing age (OR: 1.02; 95% CI: 1.01-1.04; P < 0.001) were associated with testing of cardiac risk; outpatient status at the time of PE diagnosis (OR: 2.24, 95% CI: 1.49-3.36; P < 0.001), cancer (OR: 1.81, 95% CI: 1.17-2.79; P = 0.008) and provoked PE (OR: 1.58, 95% CI: 1.05-2.40; P = 0.029) were associated with its absence.

CONCLUSION:

Although elderly patients and those with clinically severe PE were more likely to receive a biomarker test or an echocardiogram, these tools were used in only two-thirds of the patients with acute non-massive PE and rarely in combination.

• Authors: D Spirk, T Willenberg, D Aujesky, M Husmann, D Hayoz, T Baldi, A Brugger, B Amann-Vesti, I Baumgartner, N Kucher
• Journal: QJM : monthly journal of the Association of Physicians (QJM) Vol. 105 Issue 12 Pg. 1163-9 (Dec 2012) ISSN: 1460-2393 [Electronic] England
• PMID: 22908319 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Chemical References

• Biomarkers

Topics

• Adult
• Age Factors
• Aged
• Aged, 80 and over
• Biomarkers
• Echocardiography (methods)
• Embolectomy
• Female
• Humans
• Male
• Pulmonary Embolism (diagnosis, etiology, therapy)
• Registries
• Risk Assessment
• Switzerland (epidemiology)
• Thrombolytic Therapy
• Treatment Outcome
• Ventricular Dysfunction, Right (complications, diagnosis)