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Background To test the hypothesis that troponin I and echocardiography have an incremental prognostic value in patients with pulmonary embolism (PE).Methods and results In 91 patients with acute PE, echocardiography was performed within 4h of admission. Troponin I levels were obtained on admission and 12h thereafter. The 0.06μg/l troponin I cut-off level was identified as the most useful, high-sensitivity cut-off level for the prediction of adverse outcome by receiver operating characteristic analysis with a sensitivity and specificity of 86%, respectively. Twenty-eight (31%) patients had elevated troponin I levels (4.9±3.8μg/l). Twenty-one (23%) patients had adverse clinical outcomes including in-hospital death in five, cardiopulmonary resuscitation in four, mechanical ventilation in six, pressors in 14, thrombolysis in 14, catheter fragmentation in three, and surgical embolectomy in three. The area under the receiver operating characteristic curve from multivariate regression models for predicting adverse outcome without troponin I and echocardiography (0.765), with troponin I (0.890) or echocardiography alone (0.858), and the combination of both tests (0.900) was incremental. Three-month survival rate was highest in patients with both a normal troponin I level and a normal echocardiogram (98%). Positive predictive value for adverse clinical outcomes of the combination of echocardiography and troponin I was higher (75% (95%CI 55–88%)) compared with each test alone (echocardiography: 41%, 95% CI 28–56%; troponin I: 64%, 95% CI 46–79%).Conclusions While troponin I measurements added most of the prognostic information for identifying high-risk patients, a normal echocardiogram combined with a negative troponin I level was most useful to identify patients at lowest risk for early death. [ABSTRACT FROM PUBLISHER]

Objectives: In Switzerland there is a shortage of population-based information on heart failure (HF) incidence and case fatalities (CF). The aim of this study was to estimate HF event rates and both in- and out-of-hospital CF rates., Methods: Data on HF diagnoses coded according to I 50 (ICD 10) were taken from the Federal Hospital Statistics Database and the Cause of Death Database for the year 2005., Results: Although the total estimated number of HF events was higher for women (n = 4,201) than for men (n = 3,819), men showed higher numbers up to age group 65-74. Looking at age-specific HF cases per 100,000 population, men had higher rates in all age groups. The latter is also true of the age-standardised HF event rate (82.9/100,000 versus 51.4/100,000 population). Overall, CF was 26.3% and higher for women (32.2%) than for men (19.8%). The same is true of out-of-hospital CF but not of in-hospital CF., Conclusion: The HF event rate was 20% higher than the HF hospital discharge rate. Out-of-hospital death from HF accounted for the largest proportion of total HF deaths. Sex differences in both the number of HF events and HF event rates can be explained by the larger number of women than men aged 55+ in the Swiss population.