title: Combined utility of brain natriuretic peptide and cardiac troponin T may improve rapid triage and risk stratification in normotensive patients with pulmonary embolism.
abstract: BACKGROUND
  Evaluation of the combined utility of brain natriuretic peptide (BNP) and cardiac troponin T (cTnT) for risk stratification in normotensive patients with acute pulmonary embolism. The changing patterns of BNP and cTnT levels during the initial management of pulmonary embolism and their correlation with clinical outcome were the focus of this study.
  
  
  METHODS
  BNP and cTnT levels were measured in 28 consecutive normotensive on admission patients (age 53+/-18 years) with acute pulmonary embolism. Twenty-seven healthy age-matched volunteers served as controls (age 42+/-12 years). Blood samples from all patients were obtained during the first hour of presentation. Follow-up blood samples were acquired after 90 days.
  
  
  RESULTS
  Six patients (2%) had increased BNP (59+/-30 pmol/L) and cTnT (0.044+/-0.025 ng/mL) and RV dysfunction as diagnosed by echocardiography. Two of these patients died during follow-up as a consequence of RV failure due to pulmonary embolism. Eight patients (29%) had increased BNP (40.6+/-32.6 pmol/L) and normal cTnT at presentation. In four of these patients BNP levels remained increased after treatment (46.9+/-21.0 pmol/L). During follow-up these patients were diagnosed with chronic PE and RV pressure overload (RVSP>40 mm Hg). Fourteen patients (50%) with confirmed pulmonary embolism had normal BNP and cTnT levels at presentation, which remained normal during follow-up. These 14 patients were in good clinical condition during follow-up.
  
  
  CONCLUSIONS
  Combined use of BNP and cTnT may be useful in risk stratification of normotensive patients with acute pulmonary embolism. Patients with increased BNP and cTnT are at risk for adverse outcome. Future studies in larger numbers of patients are needed to confirm the usefulness of biomarkers in the clinical management of individual patients.
authors.affiliation: Department of Cardiology, Academic Medical Center, Amsterdam, 1100 DD, The Netherlands. i.i.tulevski@amc.uva.nl
authors.forename: Igor I
authors.initials: II
authors.lastname: Tulevski
authors.forename: Marye
authors.initials: M
authors.lastname: ten Wolde
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: van Veldhuisen
authors.forename: Jasper W M
authors.initials: JW
authors.lastname: Mulder
authors.forename: Ernst E
authors.initials: EE
authors.lastname: van der Wall
authors.forename: Harry R
authors.initials: HR
authors.lastname: Büller
authors.forename: Barbara J M
authors.initials: BJ
authors.lastname: Mulder
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure; D002303:Cardiac Output, Low / Q000209:etiology / Q000401:mortality; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism*; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011655:Pulmonary Embolism / Q000097:blood / Q000150:complications / Q000503:physiopathology*; D018570:Risk Assessment / Q000379:methods*; D014218:Triage / Q000379:methods*; D020107:Troponin T / Q000097:blood* / Q000378:metabolism; D018497:Ventricular Dysfunction, Right / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology
chemical_list: D020107:Troponin T; D020097:Natriuretic Peptide, Brain