Associations between clot burden measured by refined modified Miller score and cardiac biomarkers in patients with intermediate-high risk pulmonary embolism

Background Computed tomography pulmonary angiography (CTPA) is essential for diagnosing pulmonary embolism (PE); however, the clinical and prognostic relevance of clot burden remains uncertain. Purpose To evaluate the clinical significance and prognostic value of the refined Modified Miller Score (rMMS) in patients with intermediate- to high-risk PE. Material and Methods In total, 204 patients with intermediate- to high-risk PE who underwent baseline CTPA were included. Data on demographics, comorbidities, and biomarkers (troponin I/T, lactate, and D-dimer) were collected at admission. Patients were stratified by rMMS quartiles (Q1–Q4). Trends were analyzed using Cochran–Armitage and Jonckheere–Terpstra tests, while associations were assessed using Pearson's correlation and multivariable logistic regression. Results Baseline characteristics were comparable across quartiles. Higher rMMS was associated with alcohol use and prior arrhythmia. Increasing rMMS correlated with higher right ventricle:left ventricle ratio, increased heart rate, lower systolic blood pressure, and greater oxygen requirement. Weak correlations were observed between rMMS and lactate and troponin T, whereas no significant associations were found with troponin I or D-dimer. Crucially, rMMS was not associated with in-hospital outcomes or 1-year mortality. Conclusion The rMMS reflects right ventricular strain in PE but does not appear suitable for prognostic risk stratification or guiding management decisions.