Predictive value and optimal cut-off level of high-sensitivity troponin T in patients with acute pulmonary embolism

Abstract

Background/aims: Elevated troponin levels predict in-hospital mortality and influence decisions regarding thrombolytic therapy in patients with acute pulmonary embolism (PE). However, the usefulness of high-sensitivity troponin T (hsTnT) regarding PE remains uncertain. We aimed to establish the optimal cut-off level and compare its performance for precise risk stratification.

Methods: 374 patients diagnosed with acute PE were reviewed. PE-related adverse outcomes, a composite of PE-related deaths, cardiopulmonary resuscitation incidents, systolic blood pressure < 90 mmHg, and all-cause mortality within 30 days were evaluated. The optimal hsTnT cut-off for all-cause mortality, and the net reclassification index (NRI) was used to assess the incremental value in risk stratification.

Results: Among 343 normotensive patients, 17 (5.0%) experienced all-cause mortality, while 40 (10.7%) had PE-related adverse outcomes. An optimal hsTnT cut-off value of 60 ng/L for all-cause mortality (AUC 0.74, 95% CI 0.61-0.85, p < 0.001) was identified, which was significantly associated with PE-related adverse outcomes (OR 4.07, 95% CI 2.06-8.06, p < 0.001). Patients with hsTnT ≥ 60 ng/L were older, hypotensive, had higher creatinine levels, and right ventricular dysfunction signs. Combining hsTnT ≥ 60 ng/L with simplified pulmonary embolism severity index ≥1 provided additional prognostic information. Reclassification analysis showed a significant shift in risk categories, with an NRI of 1.016 ± 0.201 (p < 0.001).

Conclusion: We refined troponin's predictive value in patients with acute PE, proposing a new cut-off value of hsTnT ≥ 60 ng/L. Validation through large-scale studies is essential to offer clinically useful guidance for managing patient population.

Keywords: Biomarker; Pulmonary embolism; Risk assessment; Troponin T.

Figure 1

Receiver operating characteristic curve analysis to predict all-cause mortality in 343 normotensive patients. The dot indicates the optimal cut-off value of high-sensitivity troponin T, which was determined where the sum of specificity and specificity was the highest. AUC, area under the curve.

Figure 2

Receiver operating characteristic curves illustrating the binary performance of various predictors for all-cause mortality in 343 normotensive patients. hsTnT, high-sensitivity troponin T; AUC, area under the curve; sPESI, simplified pulmonary embolism severity index; RV, right ventricular; TTE, transthoracic echocardiography; NT-proBNP, N-terminal pro-B-natriuretic peptide; ECG, electrocardiogram.

Figure 3

Sankey diagram displaying the change of risk stratification according to the newly defined hsTnT cut-off level. The width of the bars is proportional to the number of patients. PE, pulmonary embolism; hsTnT, high-sensitivity troponin T.