The Clinical Significance Of Pulmonary Artery CT Obstruction Index, Cardiac Troponin â…  And Brain Natriuretic Peptide In Acute Pulmonary Embolism Patients Diagnosis And Treatment

Objective To explore the clinical and prognostic significance of Pulmonary artery CT obstruction index (CTI%), cardiac troponin I (cTnI) and brain natriuretic peptide (BNP) in patients with acute pulmonary embolism (APE).Methods 92 patients in the study were selected from the Department of Respiratory Medicine, the Second Affiliated Hospital of Kunming Medical University from January 1,2012 to September 31,2014. All the patients were required to measure BNP and cTnI in blood at their first day in hospital and patients with pulmonary embolism would be identified by CTPA within 24 hours. According to the result,56 were confirmed as patients with APE. Then the above 56 patients with APE were divided into three groups:mild pulmonary embolism (CTI%<30%), moderate pulmonary embolism (30%<CTI%<50%), and severe pulmonary embolism (CTI%≥50%).Meanwhile, the 56 APE patients were categorized into different groups in the accordance with 2014 ESC Guidelines on the Diagnosis and Management of Acute Pulmonary Embolism (hereinafter referred to as Guild method). Based on this method, the patients, after the preclusion of new Arrhythmia, the decline of blood volume and Sepsis, were grouped into high risk pulmonary embolism patients and non-high risk pulmonary embolism patients according to the conditions of their SP (whether the SP was less than 90mmHg, or SP dropped more than 40mmHg for 15 minutes. At the same time, the patients were classified into low risk pulmonary embolism patients ((PESI:Ⅰ, Ⅱ class) and moderate risk pulmonary embolism patients (PESI:2, Ⅳ class) by PESI. Then comparative analyses would be made on the differences of patients’ cTnI and BNP clinical indicators concluded from the above two methods and the differences of cTnI and BNP between APE patients and Non-APE patients. Besides, the predictive value of cTnI and BNP towards APE would be analyzed.Results The comparison between CTI% method and Guild method:1. there were no statistical differences (P> 0.05) in the mild and moderate groups of cTnI and BNP; the statistical difference was only found in the moderate BNP group; cTnI had no statistical differences.2. The correlation test between the cTnI and BNP of APE patients showed that they were positively correlated with each other (r= 0.635, P< 0.01).3. By selecting the ROC curve of cTnI and BNP to predict the critical value, it showed:when cTnI (≥0.025pg/ml) and BNP(≥70.95pg/ml) were combined, the specific degrees and positive predictive value of APE were as high as 100%. But the sensitivity and negative predictive value forecast is lower than the BNP acuity 70.95 pg/ml alone.Conclusion 1.The CTI% is similar to 2014 ESC Guidelines on the Diagnosis and Management of Acute Pulmonary Embolism concerning the risk stratification of pulmonary embolism and prognosis evaluation.2. The combined prediction of cTnI and BNP has a certain value for the diagnosis of APE.