Biomarker-based strategy for screening right ventricular dysfunction in patients with non-massive pulmonary embolism.

Abstract

OBJECTIVE:

To evaluate the usefulness of B-type natriuretic peptide and troponin I measurements in predicting right ventricular dysfunction (RVD) in non-massive pulmonary embolism.

DESIGN:

Prospective observational study.

SETTING:

University-affiliated emergency unit, cardiology and pneumology departments.

PATIENTS:

Sixty-seven patients admitted because of acute pulmonary embolism, without shock on admission, completed the study.

INTERVENTIONS:

Blood samples and echocardiography were obtained on admission for subsequent and independent assessment of B-type natriuretic peptide (BNP) and troponin I levels as well as RVD.

MEASUREMENTS AND RESULTS:

Echocardiographic RVD was diagnosed in 36 patients and was severe in 13 on admission. BNP and troponin I levels were higher in patients with RVD than in those with no RVD [62 (27-105) vs. 431 (289-556) pg/ml for BNP, p<0.001; 0.01 (0-0.09) vs. 0.16 (0.03-0.32) microg/l for troponin I, p=0.005]. The area under the receiving operating characteristic curve (AUC) for diagnosing RVD was 0.93 for BNP and 0.72 for troponin I. The troponin I level increased further when RVD was severe, compared with moderate, and the AUC was 0.91 for identifying severe RVD. Diagnoses of RVD and severe RVD were ruled out by BNP<or=100 pg/ml (30% of patients) and troponin I 0.10 microg/l (58% of patients), respectively. In-hospital death or circulatory failure occurred in nine patients; all had echographic RVD and level of BNP >100 pg/ml and troponin I >0.10 microg/l.

CONCLUSION:

In hemodynamically stable pulmonary embolism, BNP/troponin I measurement is helpful on admission, especially for ruling out RVD, i.e. patients with in-hospital high-risk.

• Authors: Damien Logeart, Lucien Lecuyer, Gabriel Thabut, Jean-Yves Tabet, Jean-Michel Tartière, Christophe Chavelas, François Bonnin, Jean-Louis Stievenart, Alain Cohen Solal
• Journal: Intensive care medicine (Intensive Care Med) Vol. 33 Issue 2 Pg. 286-92 (Feb 2007) ISSN: 0342-4642 [Print] United States
• PMID: 17165016 (Publication Type: Journal Article)

Chemical References

• Biomarkers
• Natriuretic Peptides
• Troponin
• Natriuretic Peptide, Brain

Topics

• Aged
• Biomarkers
• Female
• Humans
• Male
• Middle Aged
• Natriuretic Peptide, Brain (blood)
• Natriuretic Peptides (blood)
• Prospective Studies
• Pulmonary Embolism (blood, complications)
• ROC Curve
• Severity of Illness Index
• Troponin (blood)
• Ultrasonography
• Ventricular Dysfunction, Right (blood, complications, diagnostic imaging)