title: NT-pro-BNP levels in patients with acute pulmonary embolism are correlated to right but not left ventricular volume and function.
abstract: N-terminal pro-Brain Natriuretic Peptide (NT-pro-BNP) is primarily secreted by left ventricular (LV) stretch and wall tension. Notably, NT-pro-BNP is a prognostic marker in acute pulmonary embolism (PE), which primarily stresses the right ventricle (RV). We sought to evaluate the relative contribution of the RV to NT-pro-BNP levels during PE. A post-hoc analysis of an observational prospective outcome study in 113 consecutive patients with computed tomography (CT)-proven PE and 226 patients in whom PE was clinically suspected but ruled out by CT. In all patients RV and LV function was established by assessing ECG-triggered-CT measured ventricular end-diastolic-volumes and ejection fraction (EF). NT-pro-BNP was assessed in all patients. The correlation between RV and LV end-diastolic-volumes and systolic function was evaluated by multiple linear regression corrected for known confounders. In the PE cohort increased RVEF (β-coefficient (95% confidence interval [CI]) -0.044 (± -0.011); p<0.001) and higher RV end-diastolic-volume (β-coefficient 0.005 (± 0.001); p<0.001) were significantly correlated to NT-pro-BNP, while no correlation was found with LVEF (β-coefficient 0.005 (± 0.010); p=0.587) and LV end-diastolic-volume (β-coefficient -0.003 (± 0.002); p=0.074). In control patients without PE we found a strong correlation between NT-pro-BNP levels and LVEF (β-coefficient -0.027 (± -0.006); p<0.001) although not LV end-diastolic-volume (β-coefficient 0.001 (± 0.001); p=0.418). RVEF (β-coefficient -0.002 (± -0.006); p=0.802) and RV end-diastolic-volume (β-coefficient <0.001 (± 0.001); p=0.730) were not correlated in patients without PE. In PE patients, lower RVEF and higher RV end-diastolic-volume were significantly correlated to NT-pro-BNP levels as compared to control patients without PE. These observations provide pathophysiological ground for the well-known prognostic value of NT-pro-BNP in acute PE.
authors: Department of Thrombosis and Haemostasis, Leiden University Medical Centre, Leiden, The Netherlands. s.m.pasha@lumc.nl
authors: Sharif M
authors: SM
authors: Pasha
authors: Frederikus A
authors: FA
authors: Klok
authors: Noortje
authors: N
authors: van der Bijl
authors: Albert
authors: A
authors: de Roos
authors: Lucia J M
authors: LJ
authors: Kroft
authors: Menno V
authors: MV
authors: Huisman
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003287:Contrast Media / Q000494:pharmacology; D004562:Electrocardiography / Q000379:methods; D005260:Female; D006321:Heart / Q000502:physiology; D006439:Hemodynamics; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology; D020097:Natriuretic Peptide, Brain / Q000097:blood* / Q000502:physiology; D010446:Peptide Fragments / Q000097:blood* / Q000502:physiology; D010455:Peptides / Q000737:chemistry; D011379:Prognosis; D011655:Pulmonary Embolism / Q000097:blood*; D012044:Regression Analysis; D014057:Tomography, X-Ray Computed / Q000379:methods; D020246:Venous Thrombosis / Q000473:pathology*; D016277:Ventricular Function, Left / Q000502:physiology*; D016278:Ventricular Function, Right / Q000502:physiology*
chemical_list: D003287:Contrast Media; D010446:Peptide Fragments; D010455:Peptides; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain