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Öğe Antithrombotic treatment patterns and stroke prevention in patients with atrial fibrillation in Turkey: Inferences from GARFIELD-AF registry(Turkish Soc Cardiology, 2019) Sayin, Begum Yetis; Okutucu, Sercan; Yilmaz, Mehmet Birhan; Ozdemir, Kurtulus; Aydinlar, Ali; Sahin, Durmus Yildiray; Altun, ArmaganObjective: The corner stone of atrial fibrillation therapy includes the prevention of stroke with less adverse effects. The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) study provided data to compare treatment strategies in Turkey with other populations and every-day practice of stroke prevention management with complications. Methods: GARFIELD-AF is a large-scale registry that enrolled 52,014 patients in five sequential cohorts at > 1.000 centers in 35 countries. This study was initiated to track the evolution of global anticoagulation practice, and to study the impact of NOAC therapy in AF. A total of 756 patients from 17 enrolling sites in Turkey were in cohort 4 and 5. Treatment strategies at diagnosis initiated by CHA(2)DS(2)-VASc score, baseline characteristics of patients, treatment according to stroke and bleeding risk profiles, and INR values were analyzed in cohorts. Additionally, event rates during the first year follow up were evaluated. Results: AF patients in Turkey were mostly seen in young women. Stroke risk according to the CHADS(2) score and CHA(2)DS(2)-VASc score compared with world data. The mean of risk score values, including HAS-BLED score were lower in Turkey than in the world data. The percentage of patients receiving FXa inhibitor with or without an antiplatelet usage was more than the other drug groups. All-cause mortality was higher in Turkey. Different form world data when HAS-BLED score was above 3, the therapy was mostly changed to antiplatelet drugs in Turkey. Conclusion: In addition to deficiencies in available treatment options, patient care and clinical outcomes of patients with AF, the data of GARFIELD-AF provide data from Turkey about therapeutic strategies and best practices.Öğe Antithrombotic treatment patterns and stroke prevention in patients with atrial fibrillation in Turkey: Inferences from GARFIELD-AF registry(Turkish Soc Cardiology, 2019) Sayin, Begum Yetis; Okutucu, Sercan; Yilmaz, Mehmet Birhan; Ozdemir, Kurtulus; Aydinlar, Ali; Sahin, Durmus Yildiray; Altun, ArmaganObjective: The corner stone of atrial fibrillation therapy includes the prevention of stroke with less adverse effects. The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) study provided data to compare treatment strategies in Turkey with other populations and every-day practice of stroke prevention management with complications. Methods: GARFIELD-AF is a large-scale registry that enrolled 52,014 patients in five sequential cohorts at > 1.000 centers in 35 countries. This study was initiated to track the evolution of global anticoagulation practice, and to study the impact of NOAC therapy in AF. A total of 756 patients from 17 enrolling sites in Turkey were in cohort 4 and 5. Treatment strategies at diagnosis initiated by CHA(2)DS(2)-VASc score, baseline characteristics of patients, treatment according to stroke and bleeding risk profiles, and INR values were analyzed in cohorts. Additionally, event rates during the first year follow up were evaluated. Results: AF patients in Turkey were mostly seen in young women. Stroke risk according to the CHADS(2) score and CHA(2)DS(2)-VASc score compared with world data. The mean of risk score values, including HAS-BLED score were lower in Turkey than in the world data. The percentage of patients receiving FXa inhibitor with or without an antiplatelet usage was more than the other drug groups. All-cause mortality was higher in Turkey. Different form world data when HAS-BLED score was above 3, the therapy was mostly changed to antiplatelet drugs in Turkey. Conclusion: In addition to deficiencies in available treatment options, patient care and clinical outcomes of patients with AF, the data of GARFIELD-AF provide data from Turkey about therapeutic strategies and best practices.Öğe Association of pulmonary artery obstruction index with elevated heart-type fatty acid binding protein and short-term mortality in patients with pulmonary embolism at intermediate risk(Turkish Soc Radiology, 2012) Gul, Enes Elvin; Can, Ilknur; Guler, Ibrahim; Yesildag, Ahmet; Abdulhalikov, Turyan; Kayrak, Mehmet; Ozdemir, KurtulusPURPOSE Heart-type fatty acid binding protein (H-FABP) is a sensitive marker of myocardial injury and predictor of worse prognosis in patients with pulmonary embolism (PE). Assessment of right ventricular dysfunction and pulmonary artery obstruction index (PAOI) with computed tomography (CT) has been reported as a predictor of mortality in PE. Therefore, we aimed to assess the correlation between H-FABP and CT angiographic PAOI in PE patients at intermediate risk. MATERIALS AND METHODS Sixty-one patients (28 males; mean age, 62 +/- 17 years) with diagnosis of PE were included in this study. CT was performed in all patients, and the following parameters were evaluated: right ventricle/left ventricle ratio (RV/LV), pulmonary artery axial diameter, superior vena cava axial diameter, and PAOI determined with Qanadli score. Blood samples were assessed for H-FABP and troponin levels. Patients were followed for 30 days after discharge. RESULTS Mean PAOI was 57 +/- 18%. Eleven patients died during the follow-up period due to PE (18% mortality rate). H-FABP was positive in 21 patients (35%). There was no difference in CT parameters between patients with positive H-FABP and negative H-FABP. In addition, CT parameters were similar between patients who survived and those who did not. RV/LV ratio correlated with PAOI score. Among the biomarkers, troponin levels correlated with both RV/LV ratio and PAOI. H-FABP was an independent predictor of mortality. PAOI and RV/LV ratio did not predict 30-day mortality. CONCLUSION Although H-FABP positivity confers a bad prognosis on PE patients at intermediate risk, PAOI did not predict mortality in this group.Öğe Blunted heart rate recovery is associated with exaggerated blood pressure response during exercise testing(Springer, 2013) Dogan, Umuttan; Duzenli, Mehmet Akif; Ozdemir, Kurtulus; Gok, HasanIncreased sympathetic activity and endothelial dysfunction are the proposed mechanisms underlying exaggerated blood pressure response to exercise (EBPR). However, data regarding heart rate behavior in patients with EBPR are lacking. We hypothesized that heart rate recovery (HRR) could be impaired in patients with EBPR. A total of 75 normotensive subjects who were referred for exercise treadmill test examination and experienced EBPR were included to this cross-sectional case-control study. The control group consisted of 75 age- and gender-matched normotensive subjects without EBPR. EBPR was defined as a peak exercise systolic blood pressure (BP) a parts per thousand yen210 mmHg in men and a parts per thousand yen190 mmHg in women. HRR was defined as the difference in HR from peak exercise to 1 min in recovery; abnormal HRR was defined as a parts per thousand currency sign12 beats/min. These parameters were compared with respect to occurrence of EBPR. Mean values of systolic and diastolic BP at baseline, peak exercise, and the first minute of the recovery were significantly higher in the subjects with EBPR. Mean HRR values were significantly lower (P < 0.001) in subjects with EBPR when compared with those without. Pearson's correlation analysis revealed a significant positive correlation between the decrease in systolic BP during the recovery and degree of HRR in individuals without EBPR (r = 0.42, P < 0.001). Such a correlation was not observed in subjects with EBPR (r = 0.11, P = 0.34). The percentage of abnormal HRR indicating impaired parasympathetic reactivation was higher in subjects with EBPR (29 % vs 13 %, P = 0.02). In logistic regression analyses, HRR and resting systolic BP were the only determinants associated with the occurrence of EBPR (P = 0.001 and P < 0.001, respectively). Decreased HRR was observed in normotensive individuals with EBPR. In subjects with normal BP response to exercise, a linear correlation existed between the degree of HRR and decrease in systolic BP during the recovery period. However, such a correlation was not found in subjects with EBPR. Our data suggest that mechanisms underlying the blunting of the HRR might be associated with the genesis of EBPR. The association between the extent of HRR and adverse cardiovascular outcomes in patients with EBPR needs to be investigated in detail in future research.Öğe Differential diagnostic dilemma between pulmonary embolism and acute coronary syndrome(Wiley, 2016) Gul, Enes Elvin; Nikus, Kjell C.; Erdogan, Halil I.; Ozdemir, KurtulusAcute pulmonary embolism (PE) is a frequent life-threatening condition in emergency departments. Careful diagnosis is important, and different diagnostic tests such as electrocardiogram (ECG), biochemical markers, echocardiogram, and computed tomography are required. Although ECG is a cheap and rapid diagnostic test for pulmonary embolism, it has some limitations in the differential diagnosis of acute coronary syndrome and acute PE. Herein, we report ECG results of a patient diagnosed with acute PE mimicking acute coronary syndrome. (C) 2015 Japanese Heart Rhythm Society. Published by Elsevier B.V.Öğe The evaluation of doxorubicin-induced cardiotoxicity: Comparison of Doppler and tissue Doppler-derived myocardial performance index(Via Medica, 2012) Ayhan, S. Selim; Ozdemir, Kurtulus; Kayrak, Mehmet; Bacaksiz, Ahmet; Vatankulu, M. Akif; Eren, Onder; Koc, FatihBackground: Doxorubicin is a chemotherapeutic agent used in a wide spectrum of cancers. However, cardiotoxic effects have limited its clinical use. The early detection of doxorubicin-induced cardiotoxicity is crucial. The purpose of our study was to assess values of Doppler and tissue Doppler imaging (TDI) -derived myocardial performance index (MPI) in adult cancer patients receiving doxorubicin treatment. Methods: A total of 45 patients underwent echocardiographic examinations before any doxorubicin had been administered and then after doxorubicin. Doppler and TDI-derived MPI of left ventricular (LV) were determined in the evaluation of cardiotoxicity. Additionally, TDI-derived MPI of right ventricular (RV) was determined. Results: All patients underwent control echocardiographic examination after mean 5 +/- 1.7 months. The LV MPI obtained by both Doppler and TDI were increased after doxorubicin treatment (0.56 +/- 0.11, 0.61 +/- 0.10, p = 0,005 vs 0.51 +/- 0.09, 0.59 +/- 0.09, p = 0.001, respectively). There was no correlation between Doppler-derived MPI and cumulative doxorubicin dose (coefficient of correlation 0.11, p = 0.6). TDI-derived MPI was correlated with cumulative doxorubicin dose (coefficient of correlation 0.35, p = 0.015), but this correlation is weak (r = 0.38). The study population was divided into two groups according to doxorubicin dose (below and above 300 mg level). There was a moderate correlation between TDI-derived MPI and less than 300 mg of doxorubicin dose (coefficient of correlation 0.51, p = 0.028). However, Doppler-derived MPI was not correlated with less than 300 mg of doxorubicin dose (coefficient of correlation 0.38, p = 0.123). Also, there was no significant change in the TDI-derived RV-MPI (0.49 +/- 0.14, 0.50 +/- 0.12, p = 0.56). Conclusions: TDI-derived MPI is a useful parameter and an early indicator compared with Doppler-derived MPI in the detection of cardiotoxicity during the early stages. Also, doxorubicin administration does not affect RV function. (Cardiol J 2012; 19,4: 363-368)Öğe Management of right heart thrombi associated with acute pulmonary embolism: a retrospective, single-center experience(Aves Yayincilik, 2013) Akilli, Hakan; Gul, Enes Elvin; Aribas, Alpay; Ozdemir, Kurtulus; Kayrak, Mehmet; Erdogan, Halil IbrahimObjective: The mortality of right heart thrombi (RHT) associated with pulmonary embolism (PE) is increased about three to four times. The most devastating scenario is fragmentation of RHT and occurrence of recurrent PE. The reports regarding the management of RHT complicated with PE are very scarce in the current literature. Therefore, we report a single-center experience in this paper. Methods: From January 2006 to December 2011, data of all patients diagnosed with acute PE were analyzed retrospectively. Of the 312 acute PE cases confirmed with computed tomography, total 35 patients who were diagnosed with concomitant RHT (prevalence of 11%) by echocardiography were recruited. After excluding of six patients with metastatic malignancy a total 29 patients were accepted eligible for the analysis. In addition, catheter -induced thrombus (type B) were not included to the study. The difference between categorical variables was analyzed with Chi-square test and continuous variables were analyzed with Mann-Whitney U test. A p value of <0.05 was considered statistically significant. Results: Overall mortality was high (34%) in study population: among undergoing surgery-100%, therapy with thrombolytics -18%, and heparin -27%. Troponin levels were found significantly higher in died patients than that in survived patients (p=0.03). There was no significant difference regarding to clinical and echocardiographic characteristics of patients received heparin versus thrombolytic except for shock index (p=0.02). In addition, patients treated with heparin had increased duration of hospitalization compared to subjects treated with thrombolytic (median: 8 vs 3 days p<0.01). Conclusion: Despite of the low incidence of RHT, a mortal course is still an important problem during PE. The decision on treatment modality should be performed based on the hemodynamic parameters, laboratory findings, and bleeding risk of the patients.Öğe The neutrophil to lymphocyte ratio improves the positive predictive value of dobutamine stress echocardiography(E-Century Publishing Corp, 2015) Icli, Abdullah; Kayrak, Mehmet; Akilli, Hakan; Aribas, Alpay; Coskun, Mukremin; Ozer, Sumeyye Fatma; Ozdemir, KurtulusThe neutrophil to lymphocyte ratio (NLR) predicts cardiovascular events. The aim of this study was to determine whether NLR improved the positive predictive value (PPV) of dobutamine stress echocardiography (DSE) in patients with stable coronary artery disease (CAD). We conducted a retrospective review of laboratory and DSE data from the medical records of 1,012 patients who were divided into two groups according to the presence of ischemia and further subdivided into three groups according to the extent of ischemia (nonischemic segments, 1-3 ischemic segments, or > 3 ischemic segments). NLRs were compared among these groups. NLRs increased in patients with ischemia and correlated with the number of ischemic segments (P < 0.001). The optimal cutoff value of NLR determined using receiver operating characteristic analysis was > 2.04, and the diagnostic value of NLR for discriminating patients with >= 50% coronary stenosis in at least one of the coronary arteries from those without significant CAD was high [area under the curve (AUC) = 0.671, standard error = 0.052, P < 0.001, 95% confidence interval (CI) = 0.569-0.773)]. An NLR cutoff value of > 2.04 predicted CAD presence with significant stenosis (62.10% sensitivity and 64.10% specificity). PPV of DSE for a significant coronary artery lesion identified using coronary angiography was 73.8% (95% CI = 75.1-88.5, P < 0.001, AUC = 0.818). On including a cut-off value of > 2.04 for NLR in this multivariable predictive model, the AUC value slightly increased to 0.905 (95% CI = 85.4-95.6) and PPV of DSE increased from 73.8% to 92.6%. NLR improved PPV of DSE for patients with stable CAD.Öğe P-wave parameters and cardiac repolarization indices: Does menopausal status matter?(Elsevier Ireland Ltd, 2012) Dogan, Umuttan; Dogan, Nasuh Utku; Basarir, Ahmet Ozgur; Yildirim, Serkan; Celik, Cetin; Incesu, Feyzanur; Ozdemir, KurtulusBackground and purpose: Data regarding electrocardiographic characteristics of postmenopausal women are lacking. In this prospective, cross-sectional study, electrocardiographic P-wave parameters and cardiac repolarization indices of age-matched pre- and postmenopausal healthy women were compared. We hypothesized that menopausal status would have a significant effect on cardiac electrical activity and hence electrocardiography (ECG) recordings. Materials and methods: Twelve-lead ECG recordings were obtained from 125 consecutively recruited postmenopausal healthy women aged between 44 and 54 years. The control group consisted of 125 age-matched premenopausal women. P-wave parameters and cardiac repolarization indices were measured and compared with respect to menopausal status. Results: Demographic features of premenopausal and postmenopausal women were comparable. There were no significant differences between two groups regarding mean values of heart rate, maximum and minimum P-wave duration, P-wave dispersion, maximum and minimum QT interval, and QT dispersion. Mean values of QT interval obtained from lead V5 were also similar. Corrected values which were calculated according to Bazett and Fridericia formulas also did not differ between the groups. Mean values of Tpeak to Tend (TpTe) (p < 0.001) and corrected TpTe (p = 0.001) intervals obtained from lead V5 were significantly shorter in postmenopausal women when compared to those without menopause. Conclusion: Tpeak to Tend interval decreased significantly while QT intervals and P-wave parameters did not change in postmenopausal women when compared to premenopausal women. Association of these findings with changes in levels of sex steroids and their prognostic implications need to be elucidated with further studies. (C) 2012 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.Öğe Prognostic value of Tpeak-Tend interval in patients with acute pulmonary embolism(Biomed Central Ltd, 2015) Icli, Abdullah; Kayrak, Mehmet; Akilli, Hakan; Aribas, Alpay; Coskun, Mukremin; Ozer, Sumeyye Fatma; Ozdemir, KurtulusBackground: The aim of this study was to examine the Tpeak-Tend (Tpe/corrected Tpe) interval, which is an indicator of transmural myocardial repolarization, measured non-invasively via electrocardiogram in patients with acute pulmonary embolism (PE), and to investigate the relationship with 30-day mortality and morbidity. Methods: The study included 272 patients diagnosed with acute PE, comprising 154 females and 118 males, with a mean age of 63.1 +/- 16.8 years. Tpe/cTpe intervals were calculated from the electrocardiograms with a computer program after using a ruler or vernier caliper manual measuring tool to obtain highly sensitive measurements. The relationship between the electrocardiogram values and 30-days mortality and morbidity were measured. Results: The study group was divided into three groups according to cTpe intervals: Group 1, < 113 ms; Group 2, 113-133 ms; and Group 3, > 133 ms. White blood cell count and troponin T levels, corrected QT intervals with QRS complex durations, percentage of right ventricle dilatation with right/left-ventricular ratio, 30-day death, and combinations of these values were seen at a higher rate in Group 3 patients compared to the other groups. Kaplan-Meier analysis showed that the cTpe interval measured at > 126 ms could be used as a cut-off value in the prediction of mortality and morbidity. The cTpe cut-off values of 126 ms had sensivity, specificity, negative predictive value, and positive predictive value of 80.56 %, 59.32 %, 95.2 %, and 23.2 %, respectively. Conclusions: cTpe interval could be a useful method in early risk stratification in patients with acute PE.Öğe The relationship between red blood cell distribution width and myocardial ischemia in dobutamine stress echocardiography(Lippincott Williams & Wilkins, 2014) Akilli, Hakan; Kayrak, Mehmet; Aribas, Alpay; Alibasic, Hajrudin; Yildirim, Oguzhan; Sertdemir, Ahmet Lutfi; Ozdemir, KurtulusObjectivesAlthough elevated red blood cell distribution width (RDW) is associated with adverse outcomes in patients with cardiovascular disease, its role in demonstrating the presence and extent of myocardial ischemia for coronary artery disease is not known. The purpose of this study is to investigate the relationship between RDW and myocardial ischemia by using dobutamine stress echocardiography (DSE).MethodsA total of 917 patients were included in this prospective study. A complete blood analysis was performed for RDW before DSE. According to DSE results, patients were divided into two groups: DSE negative and DSE positive. According to the number of ischemic segments in DSE, patients were divided into three groups: no-ischemic segment, 1-3 ischemic segments, and 4 ischemic segments. In addition, coronary angiography results of DSE-positive groups were assessed in respect of RDW.ResultsThe RDW of the DSE-positive group (n=277) was higher than for the DSE-negative group (n=640) (13.51.5 vs. 12.7 +/- 1.3%, P<0.001, respectively). Elevated RDW values were also related to higher number of ischemic segments (no-ischemic segment group: 12.7 +/- 1.3, 1-3 ischemic segments group: 13.2 +/- 1.5, and 4 ischemic segments group: 14.2 +/- 1.3, P<0.001). A receiver operating curve analysis showed a cut-off value of RDW greater than 13.5% for predicting myocardial ischemia (sensitivity: 57.0%, specificity: 77.8%, positive predictive value: 52.7%, negative predictive value: 80.7%). In addition, positive predictive value of DSE was increased from 82.4 to 94.2% for detecting coronary artery disease by coronary angiography, when RDW (>13.5%) was used.ConclusionRDW is related to the presence and extent of myocardial ischemia in DSE. A high RDW increases the diagnostic accuracy of DSE.Öğe The Relationship Between Red Blood Cell Distribution Width and Myocardial Ischemia in Dobutamine Stress Echocardiography(Elsevier Science Inc, 2013) Akilli, Hakan; Kayrak, Mehmet; Aribas, Alpay; Alibasic, Hajrudin; Yildirim, Oguzhan; Sertdemir, Ahmet Lutfi; Ozdemir, Kurtulus[Abstract Not Availabe]Öğe Right coronary artery arising from the distal left circumflex artery(Turkish Soc Cardiology, 2011) Sonmez, Osman; Gul, Enes Elvin; Altunbas, Gokhan; Ozdemir, KurtulusOrigination of the right coronary artery from the distal left circumflex artery is a rare anomaly. A 63-year-old woman was admitted with subacute anteroseptal myocardial infarction. Electrocardiography showed a QS pattern in V1-V3 precordial leads without ST elevation. Cardiac enzyme levels were elevated (CKMB 186 ng/ml, troponin I 27.1 ng/ml). Echocardiography showed hypokinesia of the anterior and lateral walls without valvular pathology. Coronary angiography revealed origination of the right coronary artery from the circumflex artery. The right coronary artery had a normal flow pattern and there were atherosclerotic plaques in the circumflex artery without a significant stenosis. Distal to the first diagonal branch of the left anterior descending artery, a 95% stenotic lesion was detected, which was treated with balloon dilatation followed by implantation of a bare metal stent. The patient was discharged with near-complete patency and without any complication.Öğe Right ventricular involvement in anterior myocardial infarction: a tissue Doppler-derived strain and strain rate study(Elsevier Espana, 2013) Sonmez, Osman; Kayrak, Mehmet; Altunbas, Gokhan; Abdulhalikov, Turyan; Alihanoglu, Yusuf; Bacaksiz, Ahmet; Ozdemir, KurtulusOBJECTIVE: Strain and strain rate imaging is currently the most popular echocardiographic technique that reveals subclinical myocardial damage. There are currently no available data on this imaging method with regard to assessing right ventricular involvement in anterior myocardial infarction. Therefore, we aimed to evaluate right ventricular regional functions using a derived strain and strain rate imaging tissue Doppler method in patients who were successfully treated for their first anterior myocardial infarction. METHODS: The patient group was composed of 44 patients who had experienced their first anterior myocardial infarction and had undergone successful percutaneous coronary intervention. Twenty patients were selected for the control group. The right ventricular myocardial samplings were performed in three regions: the basal, mid, and apical segments of the lateral wall. The individual myocardial velocity, strain, and strain rate values of each basal, mid, and apical segment were obtained. RESULTS: The right ventricular myocardial velocities of the patient group were significantly decreased with respect to all three velocities in the control group. The strain and strain rate values of the right mid and apical ventricular segments in the patient group were significantly lower than those of the control group (excluding the right ventricular basal strain and strain rate). In addition, changes in the right ventricular mean strain and strain rate values were significant. CONCLUSION: Right ventricular involvement following anterior myocardial infarction can be assessed using tissue Doppler based strain and strain rateÖğe Short-term warfarin treatment for apical thrombus in a patient with Takotsubo cardiomyopathy(Clinics Cardive Publ Pty Ltd, 2016) Icli, Abdullah; Akilli, Hakan; Kayrak, Mehmet; Aribas, Alpay; Ozdemir, KurtulusTakotsubo cardiomyopathy (TCMP) is characterised by a temporary aneurysm of the left ventricular apex in individuals without significant stenosis of the coronary arteries. It is extremely rare to see it combined with a thrombus. In this case report, we present a 57-year-old female patient with TCMP in whom apical thrombus was treated with short-term warfarin use.Öğe Thrombolysis in patients with pulmonary embolism and elevated heart-type fatty acid-binding protein levels(Springer, 2014) Gul, Enes Elvin; Can, Ilknur; Kayrak, Mehmet; Abdulhalikov, Turyan; Erdogan, Halil Ibrahim; Altunbas, Gokhan; Ozdemir, KurtulusRecent studies have reported that a novel cardiac biomarker, heart-type fatty acid-binding protein (h-FABP), significantly predicts mortality inpatients with pulmonary embolism (PE) at intermediate risk. The aim of this study was to evaluate the effect of thrombolytic therapy on prognosis of the intermediate risk acute PE patients with elevated levels of h-FABP. This is non-interventional, prospective, and single-center cohort study where 80 patients (mean age 62 +/- A 17 years, 32 men) with confirmed acute PE were included. Only patients with PE at intermediate risk (echocardiographic signs of right ventricular overload but without evidence for hypotension or shock) were included in the study. h-FABP and other biomarkers were measured upon admission to the emergency department. Thrombolytic (Thrl) therapy was administered at the physician's discretion. Of the included 80 patients, 24 were h-FABP positive (30 %). 14 patients (58 %) with positive h-FABP had clinical deterioration during the hospital course and required inotropic support and 12 of these patients died. However, of 56 patients with negative test, only 7 patients worsened or needed inotropic support and five patients died during the hospital stay. Mortality of patients with PE at intermediate risk was 21 %. The 30-day mortality rate was significantly higher in h-FABP(+) patients compared to h-FABP(-) patients (9 vs. 50 %, p < 0.001). Multivariate analysis revealed h-FABP as the only 30 day mortality predictor (HR 7.81, CI 1.59-38.34, p = 0.01). However, thrl therapy did dot affect the survival of these high-risk patients. Despite, h-FABP was successful to predict 30-days mortality in patients with PE at intermediate risk; it is suggested to be failed in determining the patients who will benefit from thrl therapy.
