Follow Us:Respiratio 2019; 9 (1-2): 1-6
THE ROLE OF N-TERMINAL PRO-BRAIN NATRIURETIC PEPTIDE IN
THE ASSESSMENT OF RIGHT VENTRICULAR DYSFUNCTION IN
PATIENTS WITH ACUTE PULMONARY EMBOLISM: RESULTS FROM
SERBIAN UNIVERSITY PULMONARY EMBOLISM REGISTRY (SUPER)
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
Abstract
Background: 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
dysfunction
References
|
1. Silverstein MD, Heit JA, Mohr DN. Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. Arch Intern Med 1998; 158(6):585-593 [CrossRef] |
|
|
|
|
|
2. Cho JH, Kutti Sridharan G, Kim SH. Right ventricular dysfunction as an echocardiographic prognostic factor in hemodynamically stable patients with acute pulmonary embolism: a meta- analysis. BMC Cardiovasc Disord 2014; 14:64 [CrossRef] |
|
|
|
|
|
3. Kucher N, Rossi E, De Rosa M, Goldhaber SZ. Massive pulmonary embolism. Circulation 2006; 113(4):577-582 [CrossRef] |
|
|
|
|
|
4. Alpert JS, Smith R, Carlson J. Mortality in patients treated for pulmonary embolism. JAMA 1976; 236(13):1477-1480
|
|
|
|
|
|
5. Grifoni S, Olivotto I, Cecchini P. Short- term clinical outcome of patients with acute pulmonary embolism, normal blood pressure, and echocardiographic right ventricular dysfunction. Circulation 2000;101(24):2817-2822 [CrossRef] |
|
|
|
|
|
6. Meyer T, Binder L, Hruska N. Cardiac troponin I elevation in acute pulmonary embolism is associated with right ventricular dysfunction. J Am Coll Cardiol 2000; 36(5):1632-1636 |
|
|
|
|
|
7. Pieralli F, Olivotto I, Vanni S. Usefulness of bedside testing for brain natriuretic peptide to identify right ventricular dysfunction and outcome in normotensive patients with acute pulmonary embolism. Am J Cardiol 2006; 97(9):1386-1390 [CrossRef] |
|
|
|
|
|
8. Torbicki A, Perrier A, Konstantinides S, Agnelli G, Galiè N, Pruszczyk P. Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology. Eur Heart J 2008; 29: 2276-315. [CrossRef] |
|
|
|
|
|
9. Ruskoaho H. Cardiac hormones as diagnostic tools in heart failure. Endocr Rev 2003; 24: 341-56. [CrossRef] |
|
|
|
|
|
10. Krüger S, Graf J, Merx MW, Koch KC, Kunz D, Hanrath P. Brain natriuretic peptide predicts right heart failure in patients with acute pulmonary embolism. Am Heart J 2004; 147: 60-5. |
|
|
|
|
|
11. Choi HS, Kim KH, Yoon HJ, Hong YJ, Kim JH, Ahn Y. Usefulness of cardiac biomarkers in the prediction of right ventricular dysfunction before echocardiography in acute pulmonary embolism. J Cardiol 2012; 60: 508-13. [CrossRef] |
|
|
|
|
|
12. Pruszczyk P, Kostrubiec M, Bochowicz A, Styczy?ski G, Szulc M, Kurzyna M. N-terminal probrain natriuretic peptide in patients with acute pulmonary embolism. Eur Respir J 2003; 22: 649-53. [CrossRef] |
|
|
|
|
|
13. Vuilleumier N, Le Gal G, Cornily JC, Hochstrasser D, Bounameaux H, Aujesky D. Is NT-proBNP superior to clinical scores for risk stratification in non-massive pulmonary embolism? J Thromb Haemost 2010; 8: 1433-5. [CrossRef] |
|
|
|
|
|
14. Agterof MJ, Schutgens RE, Snijder RJ, Epping G, Peltenburg HG, Posthuma EF. Out of hospital treatment of acute pulmonary embolism in patients with a low NT-proBNP level. J Thromb Haemost 2010; 8: 1235-41. [CrossRef] |
|
|
|
|
|
15. Binder L, Pieske B, Olschewski M, Geibel A, Klostermann B, Reiner C. N-terminalpro-brain natriuretic peptide or troponin testing followed by echocardiography for risk stratification of acutepulmonary embolism. Circulation 2005; 112: 1573-9. [CrossRef] |
|
|
|
|
|
16. Andreassen AK, Wergeland R, Simonsen S, Geiran O, Guevara C, Ueland T. N-terminal pro-B-type natriuretic peptide as an indicator of disease severity in a heterogeneous group of patients with chronic precapillary pulmonary hypertension. Am J Cardiol 2006; 98: 525-9.
|
|
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).