[Biohumoral markers and right ventricular dysfunction in acute pulmonary embolism: the answer to thrombolytic therapy].
BACKGROUND
Recent data suggest that brain natriuretic peptide (BNP) and troponin I (TnII) are useful markers of right ventricular dysfunction (RVD) and initial myocardial injury in acute pulmonary embolism. The aim of this study was to evaluate biohumoral activation and right ventricular function in patients with acute pulmonary embolism diagnosed at pulmonary scintigraphy.


METHODS
We observed 12 patients with massive pulmonary embolism (MPE), 8 with non-massive pulmonary embolism (NMPE) and RVD, 6 with NMPE without RVD. All the patients with MPE and 5 patients with NMPE-RVD received thrombolytic therapy (urokinase or recombinant tissue-type plasminogen activator), the others were treated with heparin. At the beginning and after pharmacological treatment all the 26 patients underwent standard echocardiography and blood test analysis.


RESULTS
BNP and Tn1 were significantly high in MPE (BNP p < 0.001 and Tn1I p < 0.005 vs NMPE) and in NMPE-RVD (BNP p < 0.03 and Tnl p < 0.02 vs NMPE). MPE and NMPE-RVD had similar RVD (p = NS), thrombolysis significantly reduced BNP, TnI, systolic pulmonary pressure, both in MPE (p < 0.001) and in NMNPE-RVD (BNP and Tnl p < 0.05, systolic pulmonary pressure p < 0.001). COULSION: Our data sustain the utility of BNP and Tnl as markers of RVD in acute pulmonary embolism; they focus on patients with NMPE-RVD and high levels of BNP and Tnl in whom an aggressive therapy as the thrombolytic one is necessary; they suggest the importance of biohumoral markers as indicators of the efficacy of pharmacological treatment in patients with acute pulmonary embolism.
Enea
Iolanda
I
UO di Medicina d'Urgenza, Ospedale San Sebastiano, Caserta. i_enea@hotmail.com
Ceparano
Giuseppe
G
Mazzarella
Giancarlo
G
Di Sarno
Raffaele
R
Cangiano
Giuseppe
G
Busino
Ciro Angelo
CA
D000208:Acute Disease; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011655:Pulmonary Embolism / Q000097:blood / Q000150:complications* / Q000188:drug therapy*; D015912:Thrombolytic Therapy; D019210:Troponin I / Q000097:blood; D018497:Ventricular Dysfunction, Right / Q000097:blood / Q000150:complications*
D019210:Troponin I; D020097:Natriuretic Peptide, Brain