Biomarker-based strategy for screening right ventricular dysfunction in patients with non-massive pulmonary embolism.
OBJECTIVE
To evaluate the usefulness of B-type natriuretic peptide and troponin I measurements in predicting right ventricular dysfunction (RVD) in non-massive pulmonary embolism.


METHODS
Prospective observational study.


METHODS
University-affiliated emergency unit, cardiology and pneumology departments.


METHODS
Sixty-seven patients admitted because of acute pulmonary embolism, without shock on admission, completed the study.


METHODS
Blood samples and echocardiography were obtained on admission for subsequent and independent assessment of B-type natriuretic peptide (BNP) and troponin I levels as well as RVD.


RESULTS
Echocardiographic RVD was diagnosed in 36 patients and was severe in 13 on admission. BNP and troponin I levels were higher in patients with RVD than in those with no RVD [62 (27-105) vs. 431 (289-556) pg/ml for BNP, p<0.001; 0.01 (0-0.09) vs. 0.16 (0.03-0.32) microg/l for troponin I, p=0.005]. The area under the receiving operating characteristic curve (AUC) for diagnosing RVD was 0.93 for BNP and 0.72 for troponin I. The troponin I level increased further when RVD was severe, compared with moderate, and the AUC was 0.91 for identifying severe RVD. Diagnoses of RVD and severe RVD were ruled out by BNP<or=100 pg/ml (30% of patients) and troponin I 0.10 microg/l (58% of patients), respectively. In-hospital death or circulatory failure occurred in nine patients; all had echographic RVD and level of BNP >100 pg/ml and troponin I >0.10 microg/l.


CONCLUSIONS
In hemodynamically stable pulmonary embolism, BNP/troponin I measurement is helpful on admission, especially for ruling out RVD, i.e. patients with in-hospital high-risk.
Logeart
Damien
D
Service de Cardiologie, Hôpital Lariboisière, 2 rue Ambroise Paré, 75010, Paris, France. damien.logeart@lrb.ap-hop-paris.fr
Lecuyer
Lucien
L
Thabut
Gabriel
G
Tabet
Jean-Yves
JY
Tartière
Jean-Michel
JM
Chavelas
Christophe
C
Bonnin
François
F
Stievenart
Jean-Louis
JL
Solal
Alain Cohen
AC
D000368:Aged; D015415:Biomarkers; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D045265:Natriuretic Peptides / Q000097:blood*; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000097:blood / Q000150:complications*; D012372:ROC Curve; D012720:Severity of Illness Index; D014336:Troponin / Q000097:blood*; D014463:Ultrasonography; D018497:Ventricular Dysfunction, Right / Q000097:blood* / Q000150:complications* / Q000000981:diagnostic imaging
D015415:Biomarkers; D045265:Natriuretic Peptides; D014336:Troponin; D020097:Natriuretic Peptide, Brain