Combination of D-dimer and amino-terminal pro-B-type natriuretic Peptide testing for the evaluation of dyspneic patients with and without acute pulmonary embolism.
BACKGROUND
D-dimer concentration can be used to exclude a diagnosis of acute pulmonary embolism. However, clinicians frequently order unnecessary supplemental testing in patients with low concentrations of D-dimer. Elevations in natriuretic peptides have also been described in the setting of pulmonary embolism.


OBJECTIVE
We investigated the integrative role of D-dimer with amino-terminal pro-B-type natriuretic peptide for the evaluation of patients with and without acute pulmonary embolism.


METHODS
Patients were selected for analysis from a previous study in which levels of D-dimer and amino-terminal pro-B-type natriuretic peptide were measured. The presence of pulmonary embolism was determined by computed tomographic angiography.


RESULTS
The median levels of D-dimer were significantly higher in patients with acute pulmonary embolism. Similarly, the median levels of amino-terminal pro-B-type natriuretic peptide were higher in patients with pulmonary embolism.


CONCLUSIONS
The Roche Tina-quant D-Dimer immunoturbidimetric assay provides a high negative predictive value and can be used to exclude acute pulmonary embolism in patients with dyspnea. Measurement of amino-terminal pro-B-type natriuretic peptide in addition to D-dimer improves specificity for acute pulmonary embolism without sacrificing negative predictive value. A combination of both markers may offer reassurance for excluding acute pulmonary embolism, and thus avoid redundant, expensive confirmatory tests.
Melanson
Stacy E F
SE
Department of Pathology, Division of Clinical Laboratories, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass, USA.
Laposata
Michael
M
Camargo
Carlos A
CA
Chen
Annabel A
AA
Tung
Roderick
R
Krauser
Dan
D
Anwaruddin
Saif
S
Baggish
Aaron
A
Cameron
Renee
R
Sluss
Patrick
P
Lewandrowski
Kent B
KB
Lee-Lewandrowski
Elizabeth
E
Januzzi
James L
JL
D000208:Acute Disease; D015415:Biomarkers / Q000032:analysis; D003937:Diagnosis, Differential; D004417:Dyspnea / Q000209:etiology / Q000473:pathology*; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D006801:Humans; D020097:Natriuretic Peptide, Brain / Q000097:blood* / Q000737:chemistry; D010446:Peptide Fragments / Q000097:blood*; D011655:Pulmonary Embolism / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology*; D012016:Reference Values; D014057:Tomography, X-Ray Computed
D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; D010446:Peptide Fragments; C036309:fibrin fragment D; D020097:Natriuretic Peptide, Brain