title: 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.
abstract: 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.
authors.affiliation: Department of Pathology, Division of Clinical Laboratories, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass, USA.
authors.forename: Stacy E F
authors.initials: SE
authors.lastname: Melanson
authors.forename: Michael
authors.initials: M
authors.lastname: Laposata
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Camargo
authors.forename: Annabel A
authors.initials: AA
authors.lastname: Chen
authors.forename: Roderick
authors.initials: R
authors.lastname: Tung
authors.forename: Dan
authors.initials: D
authors.lastname: Krauser
authors.forename: Saif
authors.initials: S
authors.lastname: Anwaruddin
authors.forename: Aaron
authors.initials: A
authors.lastname: Baggish
authors.forename: Renee
authors.initials: R
authors.lastname: Cameron
authors.forename: Patrick
authors.initials: P
authors.lastname: Sluss
authors.forename: Kent B
authors.initials: KB
authors.lastname: Lewandrowski
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Lee-Lewandrowski
authors.forename: James L
authors.initials: JL
authors.lastname: Januzzi
mesh_terms: 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
chemical_list: D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; D010446:Peptide Fragments; C036309:fibrin fragment D; D020097:Natriuretic Peptide, Brain