Nazim Hussain Bokhari, Naeem M.
Evaluation of Serum Angiotensin Converting Enzyme (SACE) as a diagnostic marker for Pulmonary Embolism.
Pak J Med Sci Jan ;18(4):297-301.

Objective: A number of supportive laboratory tests such as ECG, Chest x-ray, ABGs, SLDH, SGOT, S. Bilirubin and D-dimer with variable sensitivity and specificity are available to facilitate the clinical diagnosis of acute Pulmonary Embolism (PE). Serum Angiotensin Converting Enzyme (SACE) which is produced mainly by the pulmonary vascular endothelial cells, is found altered during a variety of diffuse lung diseases. This study was designed to evaluate the validity of SACE level as a marker for hypoxic damage to the pulmonary endothelium in PE. Design: A prospective study carried out on forty patients with high clinical suspicion of PE. Besides routine diagnostic tests mentioned above all of them had Ventilation Perfusion isotope (V/Q) scans (as a diagnostic test) and SACE level checked. Setting: Shaikh Zayed Hospital Lahore. Results. Among forty consecutive patients with age range 25-59 years (mean: 42 Yr), twenty six patients (65%) with abnormal scans reported as High Probability` were included in group-A (True Positive), whereas 14(35%) patients having Low-Probability (Suspected) or Normal scan were included in group-B, Low SACE level (<28iu/L) was found in 19/26 (sensitivity of 73%) in Group-A (Positive Predictive Value: 47%) and 9/14 (sensitivity of 64%) in Group-B, whereas mean levels for both groups were 34.55 and 54.84 respectively. Rise in LDH was pronounced in Group-A. Only chest X-ray and ECGs were found to be more sensitive for group-A than group-B. Changes in ABGs (Type-1 Resp. Failure) had low sensitivity. Conclusion: Among clinically suspected cases of PE, fall in SACE level can be used as a sensitive and reliable diagnostic marker as more than 75% of the enzyme is produced in the lungs compared with other enzymes which have extra-pulmonary source.

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