[Interest of the brain natriuretic peptide as a marker of acute cor pulmonale in acute respiratory distress syndrome].
OBJECTIVE
The aim of this study was to evaluate the accuracy of the BNP as a marker of acute cor pulmonale in patients with ARDS.


METHODS
Prospective clinical trial.


METHODS
At day 2 or 3 after the onset of the ARDS, an echocardiography was performed. Patients with left ventricular dysfunction were excluded. Right ventricular area (RVA) and RVA/LVA ratio were measured. ACP was defined as RVA/LVA > 0.6 associated with septal dyskinesia. Simultaneously, 5 ml of blood was collected for BNP measurement.


RESULTS
26 patients were studied. BNP levels were higher in 10 patients with ACP: 585.5 [189-4830] vs 145.5 [36.5-346] pg/ml (P=0.01) but in those with creatinine clearance < 90 ml/min: 602 [331-3530] vs 125 [39-189] pg/ml (P=0.007). BNP was correlated with RVA (r=0.5; p=0.01), RVA/LVA ratio (r=0.61; p=0.001), sPAP (r=0.58; p=0.002) and with age, cardiac index and creatinine clearance (r=0.61; p=0.001). In multivariate analysis, BNP was only correlated with creatinine clearance (p=0.03), and RVA (p=0.06).


CONCLUSIONS
In ARDS patients without left ventricular dysfunction, BNP level is more elevated in patients with acute cor pulmonale than patients without cor pulmonale.
Thierry
S
S
Service de Réanimation Polyvalente, Hôpital Louise-Michel, Centre Hospitalier Sud-Francilien, 91014 Evry, France. stephane.thierry@ch-sud-francilien.fr
Lecuyer
L
L
Brocas
E
E
Van de Louw
A
A
Hours
S
S
Moreau
M-H
MH
Boiteau
R
R
Tenaillon
A
A
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000375:Aging / Q000378:metabolism; D015415:Biomarkers; D003404:Creatinine / Q000652:urine; D004452:Echocardiography; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011446:Prospective Studies; D011660:Pulmonary Heart Disease / Q000097:blood* / Q000000981:diagnostic imaging / Q000209:etiology*; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000097:blood* / Q000150:complications*; D016278:Ventricular Function, Right / Q000502:physiology
D015415:Biomarkers; D020097:Natriuretic Peptide, Brain; D003404:Creatinine