[Troponin-I in hemodynamically-stable pulmonary embolism: correlation with echocardiography and computed tomography angiography]. / Troponina-I en el tromboembolismo pulmonar hemodinámicamente estable: correlación con la ecocardiografía y la angiografía por tomografía computarizada.

BACKGROUND: Troponin-I (TnI) is a marker of severe pulmonary thromboembolism (PTE) in unselected patients. There are few articles that assess its usefulness in hemodynamically-stable patients. OBJECTIVES: To assess the correlation between TnI levels and both echocardiographic/radiologic signs of right ventricle (RV) dysfunction or pulmonary hypertension (PH), and the severity of the pulmonary vascular obstruction. METHODS: We selected patients from a prospective cohort of 103 consecutive patients with PTE and systolic arterial pressure ≥ 90 mmHg. Computed tomography pulmonary angiography (CTPA) and echocardiography were performed in all patients. We performed a post hoc study, analyzing the 68 cases in which TnI was measured, at the discretion of the emergency room physician. RESULTS: Patients included had a median age of 74 years and 50% were male. The patients with elevated TnI had a differentiated clinical profile, suggestive of more severe PTE. There was a significant correlation between TnI levels and systolic pulmonary artery pressure (r=0.46, P<.001), the CTPA-measured pulmonary artery diameter (r=0.48, P<.001), the CTPA-measured RV diameter (r=0.47, P=.001) and the pulmonary vascular obstruction index (r=0.39, P=.001). CONCLUSION: The higher levels of TnI in patients with hemodynamically stable PTE predicts the existence of more severe PE in hemodynamically-stable patients. This biomarker could be used in the clinical practice to select those patients who might require more intensive monitoring or additional complementary studies.

Troponina-I en el tromboembolismo pulmonar hemodinámicamente estable: correlación con la ecocardiografía y la angiografía por tomografía computarizada / Troponin-I in hemodynamically-stable pulmonary embolism: correlation with echocardiography and computed tomography angiography

Antecedentes. La troponina-I (TnI) es un marcador de gravedad en pacientes no seleccionados con tromboembolismo pulmonar (TEP). Hay pocos trabajos que valoren su utilidad en pacientes hemodinámicamente estables. Objetivos. valorar la correlación entre los niveles de TnI y la existencia de signos ecocardiográficos y radiológicos de disfunción de ventrículo derecho (VD) o de hipertensión pulmonar (HTP), así como con la intensidad de la obstrucción vascular. Métodos. Se seleccionaron pacientes de un estudio prospectivo previo que incluyó 103 sujetos consecutivos con TEP y presión arterial sistémica ≥ 90 mmHg, realizándose en todos los casos angiografía por tomografía computarizada (TC) y ecocardiograma. Se realiza un estudio post hoc, en el que se analizan los 68 casos en que, según el criterio clínico del facultativo de urgencias, se realizó medición de TnI. Resultados. Mediana de edad: 74 años. El 50% eran varones. Los pacientes con elevación de la TnI presentaron un perfil clínico diferenciado, sugestivo de TEP más grave. Existió una correlación significativa entre los niveles de TnI y la presión arterial pulmonar sistólica (r=0,46, p<0,001), el diámetro de la arteria pulmonar (r=0,48, p<0,001) y del VD (r=0,47, p=0,001) medidos por TC, y el índice de obstrucción vascular pulmonar (r=0,39, p=0,001). Conclusión. En pacientes con TEP hemodinámicamente estable, los niveles más elevados de TnI predicen la existencia de un TEP más grave, y podrían usarse en la práctica clínica para seleccionar a aquellos pacientes que precisan un seguimiento clínico, o mediante pruebas complementarias, más estrecho(AU)

Background. Troponin-I (TnI) is a marker of severe pulmonary thromboembolism (PTE) in unselected patients. There are few articles that assess its usefulness in hemodynamically-stable patients. Objectives. To assess the correlation between TnI levels and both echocardiographic/radiologic signs of right ventricle (RV) dysfunction or pulmonary hypertension (PH), and the severity of the pulmonary vascular obstruction. Methods. We selected patients from a prospective cohort of 103 consecutive patients with PTE and systolic arterial pressure ≥ 90 mmHg. Computed tomography pulmonary angiography (CTPA) and echocardiography were performed in all patients. We performed a post hoc study, analyzing the 68 cases in which TnI was measured, at the discretion of the emergency room physician. Results. Patients included had a median age of 74 years and 50% were male. The patients with elevated TnI had a differentiated clinical profile, suggestive of more severe PTE. There was a significant correlation between TnI levels and systolic pulmonary artery pressure (r=0.46, P<.001), the CTPA-measured pulmonary artery diameter (r=0.48, P<.001), the CTPA-measured RV diameter (r=0.47, P=.001) and the pulmonary vascular obstruction index (r=0.39, P=.001). Conclusion. The higher levels of TnI in patients with hemodynamically stable PTE predicts the existence of more severe PE in hemodynamically-stable patients. This biomarker could be used in the clinical practice to select those patients who might require more intensive monitoring or additional complementary studies(AU)

Exhaled nitric oxide predicts control in patients with difficult-to-treat asthma.

We aimed to evaluate the accuracy of baseline exhaled nitric oxide fraction (F(eNO)) to recognise individuals with difficult-to-treat asthma who have the potential to achieve control with a guideline-based stepwise strategy. 102 consecutive patients with suboptimal asthma control underwent stepwise increase in the treatment with maximal fluticasone/salmeterol combination dose for 1 month. Then, those who remained uncontrolled received oral corticosteroids for an additional month. With this approach, 53 patients (52%) gained control. Those who achieved control were more likely to have positive skin results (60.4% versus 34%; p = 0.01), positive bronchodilator test (57.1% versus 35.8%; p = 0.02) and peak expiratory flow variability > or =20% (71.1% versus 49.1%; p = 0.04). Conversely, depression was more frequent in those who remained uncontrolled (18.4 % versus 43.4 %; p = 0.01). An F(eNO) value > or =30 ppb demonstrated a sensitivity of 87.5% (95% CI 73.9-94.5%) and a specificity of 90.6% (95% CI 79.7-95.9%) for the identification of responsive asthmatics. The current results suggest that F(eNO) can identify patients with difficult-to-treat asthma and the potential to respond to high doses of inhaled corticosteroids or systemic steroids.