title: Helical computerized tomography and NT-proBNP for screening of right ventricular overload on admission and at long term follow-up of acute pulmonary embolism.
abstract: BACKGROUND
  Right ventricular dysfunction (RVD) in acute pulmonary embolism (APE) can be assessed with helical computerized tomography (CT) and transthoracic echocardiography (TTE). Signs of RVD and elevated natriuretic peptides like NT-proBNP and cardiac troponin (TnT) are associated with increased risk of mortality. However, the prognostic role of both initial diagnostic strategy and the use of NT-proBNP and TnT for screening for long-term probability of RVD remains unknown. The aim of the study was to determine the role of helical CT and NT-proBNP in detection of RVD in the acute phase. In addition, the value of NT-proBNP for ruling out RVD at long-term follow-up was assessed.
  
  
  METHODS
  Sixty-three non-high risk APE patients were studied. RVD was assessed at admission in the emergency department by CT and TTE, and both NT-proBNP and TnT samples were taken. These, excepting CT, were repeated seven months later.
  
  
  RESULTS
  At admission RVD was detected by CT in 37 (59 %) patients. RVD in CT correlated strongly with RVD in TTE (p < 0.0001). NT-proBNP was elevated (≥ 350 ng/l) in 32 (86 %) patients with RVD but in only seven (27 %) patients without RVD (p < 0.0001). All the patients survived until the 7-month follow-up. TTE showed persistent RVD in 6 of 63 (10 %) patients who all had RVD in CT at admission. All of them had elevated NT-proBNP levels in the follow-up compared with 5 (9 %) of patients without RVD (p < 0.0001).
  
  
  CONCLUSIONS
  TTE does not confer further benefit when helical CT is used for screening for RVD in non-high risk APE. All the patients who were found to have RVD in TTE at seven months follow-up had had RVD in the acute phase CT as well. Thus, patients without RVD in diagnostic CT do not seem to require further routine follow-up to screen for RVD later. On the other hand, persistent RVD and thus need for TTE control can be ruled out by assessment of NT-proBNP at follow-up. A follow-up protocol based on these findings is suggested.
authors.affiliation: Helsinki Malmi City Hospital, Department of Emergency care, POB 6501, 00099 Helsinki City, Finland. mia.laiho@fimnet.fi
authors.forename: Mia K
authors.initials: MK
authors.lastname: Laiho
authors.forename: Veli-Pekka
authors.initials: VP
authors.lastname: Harjola
authors.forename: Marit
authors.initials: M
authors.lastname: Graner
authors.forename: Anneli
authors.initials: A
authors.lastname: Piilonen
authors.forename: Merja
authors.initials: M
authors.lastname: Raade
authors.forename: Pirjo
authors.initials: P
authors.lastname: Mustonen
mesh_terms: D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011655:Pulmonary Embolism / Q000097:blood* / Q000000981:diagnostic imaging*; D018709:Statistics, Nonparametric; D036542:Tomography, Spiral Computed; D020107:Troponin T / Q000097:blood; D018497:Ventricular Dysfunction, Right / Q000097:blood* / Q000000981:diagnostic imaging*
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; D020107:Troponin T; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain