Cardiac biomarkers for risk stratification in non-massive  pulmonary embolism: a multicenter prospective study.
BACKGROUND
Troponins (cTnI and cTnT), N-terminal pro-Brain Natriuretic Peptide (NT-proBNP), myoglobin, heart-type fatty acid-binding protein (H-FABP) and fibrin D-Dimer are emergent candidates for risk stratification in pulmonary embolism (PE).


OBJECTIVE
To compare the respective prognostic values of biomarker with non-massive PE to predict an adverse outcome at 3 months.


METHODS
One hundred and forty-six consecutive patients with non-massive PE were included in this multicenter prospective study. The combined outcome consisted of intensive care monitoring on admission, death or hospitalization attributable to either a PE-related complication [defined by PE/deep vein thrombosis (DVT) relapse or major bleeding under anticoagulation] or to dyspnoea with or without chest pain during follow-up.


RESULTS
The outcome was met in 12% of patients. In univariate analysis, a NT-proBNP level above 300 pg/ml was the strongest predictor of unfavorable outcome with an odds ratio (OR) of 15.8 [95% confidence interval (CI): 2.05-122). ORs for the other variables were: 8.0 for D-dimer >2000 ng/ml (95% CI: 1.1-64), 4.7 for H-FABP >6 ng/ml (95% CI:1.5-14.8), 3.5 for cTnI >0.09 ng/ml (95% CI:1.2-9.7), 3.4 for myoglobin >70 ng/ml (95% CI:0.9-12.2). Receiver operating curve (ROC) analysis indicated that NT-proBNP was the best predictor [area under the curve (AUC) 0.84; 95%CI: 0.76-0.92; P < 0.0001] with a negative predictive value of 100% (95% CI: 91-100) at 300 pg/ml. At that cut-off, the true negative rate for NT-proBNP was 40%. In multivariate analysis, NT-proBNP was the only significant independent predictors.


CONCLUSIONS
NT-proBNP appears to be a good risk stratification marker in identifying low-risk patients with non-massive PE who could be treated in an outpatient setting.
Vuilleumier
N
N
Division of Laboratory Medicine, Department of Genetics and Laboratory Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland. nicolas.vuilleumier@hcuge.ch
Le Gal
G
G
Verschuren
F
F
Perrier
A
A
Bounameaux
H
H
Turck
N
N
Sanchez
J-C
JC
Mensi
N
N
Perneger
T
T
Hochstrasser
D
D
Righini
M
M
D000293:Adolescent; D000328:Adult; D015415:Biomarkers; D050556:Fatty Acid-Binding Proteins / Q000097:blood; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D006801:Humans; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D016017:Odds Ratio; D010446:Peptide Fragments / Q000097:blood; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000175:diagnosis*; D018570:Risk Assessment; D014336:Troponin / Q000097:blood; D055815:Young Adult
D015415:Biomarkers; D050556:Fatty Acid-Binding Proteins; D005338:Fibrin Fibrinogen Degradation Products; D010446:Peptide Fragments; D014336:Troponin; C036309:fibrin fragment D; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain