doi: 10.1161/01.CIR.0000127106.85030.4A
(Circulation. 2004;109:e194.)
© 2004 American Heart Association, Inc.
Correspondence |
Serum Myoglobin in Pulmonary Embolism
Department of Internal Medicine and Hypertension, The Medical University of Warsaw, Banacha 1a, 02–096 Warsaw, Poland, piotr.pruszczyk{at}amwaw.edu.pl
To The Editor:
N. Kucher and S.Z. Goldhaber discuss the potential role of cardiac troponins and brain natruretic peptides in the risk stratification of patients with acute pulmonary embolism (APE).1 Increased levels of cardiac troponins indicate myocardial damage in an overloaded right ventricular myocardium. Interestingly, right ventricular infarctions were reported in patients who died from massive APE2 and in survivors with angiographically normal coronary arteries.3 Myoglobin, a highly sensitive marker of myocardial injury, can be elevated after myocardial damage, even before any detectable rise of cardiac troponin levels occurs.4 However, to our knowledge, measurement of serum myoglobin levels has not been evaluated in APE. Therefore, we checked the prevalence and prognostic significance of elevated serum myoglobin levels in 46 patients with major APE.5 Our study showed that on admission, myoglobin serum concentrations are elevated in 45% of APE patients. All 7 in-hospital deaths occurred in the group with elevated serum myoglobin, and in one fatal case, cardiac troponin T measured simultaneously was negative. Moreover, elevated serum myoglobin was a significant predictor of fatal outcome (odds ratio 25, 95% confidence interval 1.3 to 474.2). We think that both cardiac troponins and myoglobin, a biochemical marker of myocardial injury, are powerful predictors of increased risk of fatal outcome in major pulmonary embolism.
References
1. Kucher N, Goldhaber SZ. Cardiac biomarkers for risk stratification of patients with acute pulmonary embolism. Circulation. 2003; 108: 2191–2194.
2. Coma-Canella I, Gamallo C, Martinez Onsurbe P, et al. Acute right ventricular infarction secondary to massive pulmonary embolism. Eur Heart J. 1988; 9: 534–540.
3. Pruszczyk P, Szulc M, Horszczaruk G, et al. Right ventricular infarction in a patient with acute pulmonary embolism and normal coronary arteries. Arch Intern Med. 2003; 163: 1110–1111.
4. de Lemos JA, Morrow DA, Gibson CM, et al. The prognostic value of serum myoglobin in patients with non-ST-segment elevation acute coronary syndromes: results from the TIMI 11B and TACTICS-TIMI 18 studies. J Am Coll Cardiol. 2002; 40: 238–244.
5. Pruszczyk P, Bochowicz A, Kostrubiec M, et al. Myoglobin stratifies short term risk in acute major pulmonary embolism. Clin Chim Acta. 2003; 338: 53–56.[CrossRef][Medline] [Order article via Infotrieve]
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