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Respiratio 2019; 9 (1-2): 1-6



Ljiljana Kos, Bojan M. Stanetic, Tamara Kovacevic-Preradovic, Miodrag Ostojic, Ljiljana
Jovanovic, Vesna Subota, Milena Stavric, Bojana Subotic, Boris Dzudovic, Natasa Novicic,
Jovan Matijasevic, Milica Miric, Sonja Salinger, Natasa Markovic-Nikolic, Maja Nikolic,
Vladimir Miloradovic, Jelena Marinkovic, Nikola Kocev, Slobodan Obradovic


Original research

Naučni članak

doi: 10.26601/rsp.aprs.19.1

Right ventricular dysfunction (RVD) is a well-known predictor of early death in
patients with acute pulmonary embolism and thus early identification of RVD is critical in the risk
stratification or management of acute pulmonary embolism (PE).
Aim of this study was to investigate a useful role of cardiac biomarker NTproBNP for predicting
echocardiographic right ventricular dysfunction in patients with acute pulmonary embolism.

Methods: A retrospective analysis was performed in 195 consecutive adult patients with pulmonary
embolism from the Serbian University Pulmonary Embolism Registry (SUPER 2015-2019) created by six
university clinics: Military Medical Academy (Belgrade), Institute of Pulmonary Diseases (Sremska
Kamenica), Clinical Center (Nis), University Clinic Zvezdara, Clinical Center (Kragujevac) and
University Clinical Centre of Republic of Srpska (Banja Luka). All patients were divided into RVD group
and non-RVD group according to whether there was increase in systolic pressure in right ventricle
(>40mmHg) on echocardiography. Odds ratios (OR) and 95% confidence intervals (CI) assessing the
risk factors for RVD were assessed by multivariate logistic regression. The ability of the NT proBNP in
predicting the RVD was described by the Receiving Operating Curves analysis.

Results: The mean age of the included patients was 63.9 ± 1.0 years, 83/195 (42.6%) were men,
28/195 (14.4%) had COPD, 17/195 (8.7%) had malignancy and 27/195 (13.9%) were diabetic and
125/195 (64.1%) had history of arterial hypertension. Patients in the RVD group showed higher right
ventricular systolic pressure (58.89 ± 15.71 vs. 35.47 ± 8.58; p<0.001), increased right ventricular
diameter (33.93 ± 7.99 vs. 28.38 ± 3.88; p<0.001) as well as decreased right ventricular systolic function
by tricuspid annular plane systolic excursion (1.66 ± 0.48 vs. 2.26 ± 0.29; p=0.001) when compared with
non-RVD group. There was no differences in Troponin I, Troponin T and D-dimer values between the
groups (111.84 ± 106.51 vs. 61.38 ± 76.68; p=0.280, 6.37 ± 5.63 vs. 0.64 ± 0.30; p=0.520, and 6268.71
± 9061.35 vs. 4415.47 ± 4837.94; p=0.168, respectively), whereas NT-proBNP was higher in RVD group
(6346.56 ± 7478.27 vs. 2888.45 ± 4941.94; p=0.001). In the multivariable logistic regression analysis,
NT-proBNP (per 100 pg/mL) was independently associated with RVD (OR 1.009 with 95% CI 1.003-
1.015; p=0.028). In addition, NT-proBNP was found to predict RVD with an area under the curve of
0.711 (95% CI 0.631-0.791). The cut-off value of NT-proBNP was 704.8 µg/mL, with a sensitivity of
81.3% and specificity of 72.9%.

Conclusion: It appears that NT-proBNP is a strong predictor of echocardiographic RVD in patients
with PE. The simple measurements of this cardiac biomarker could be helpful in clinical decision-making
or risk stratification in patients with PE.

Keywords: Pulmonary embolism; N-terminal pro-brain natriuretic peptide; Right ventricular

Full Article (PDF)


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Ljiljana Kos
Department of Cardiology, University Clinical Centre
of the Republic of, Banja Luka, Bosnia and Herzegovina
Corresponding author at e-mail address:
This email address is being protected from spambots. You need JavaScript enabled to view it. (Lj. Kos).

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