The use of serum troponin in the setting of an acute pulmonary embolism

Problem: The nonspecific signs and symptoms of an acute pulmonary embolism make it more difficult to distinguish from cardiovascular and respiratory syndromes. This problem has led to the under-detection, misdiagnosis and inappropriate treatment of thromboembolic episodes. This review is a collection of literature investigating the use of serum troponin I in diagnosing and risk stratifying an acute pulmonary embolism. Methods: The literature for this review was attained from the three Internet sources, PubMed Central, Google Scholar and Web of Science. The main search terms used were "pulmonary embolism and troponin", "pulmonary embolism and elevated troponin", "pulmonary embolism and right dysfunction", "pulmonary embolism and biomarkers," and "pulmonary embolism and mortality." Results: 23 journal articles were found for this review, but due to exclusion criteria, a total of 14 studies were used. Eight were analyzed and six were incorporated into the background. The articles used for analytical critique were Douketis et al., Gallotta et al., Vecchia et al., Shokoohi et al., Punukollu et al., Meyer et al., Stein et al. and Aujesky et al. Conclusions: The clinical utility of elevated troponin levels in risk stratifying pulmonary embolism in hemodynamically stable patients must be further investigated. Future research should verify the use of cardiac troponin concentrations, and define the characteristic troponin trend associated with an acute pulmonary embolism.