title: Assessing prognosis of pulmonary embolism using tissue-Doppler echocardiography and brain natriuretic peptide.
abstract: OBJECTIVE
  To assess prognosis of pulmonary thromboembolism using tissue Doppler echocardiography and brain natriuretic peptide.
  
  
  METHODS
  Patients aged over 18 years were evaluated within 24 hours of confirmed diagnosis (chest tomography/pulmonary scintigraphy) of pulmonary embolism using two-dimensional echocardiography and tissue Doppler for right ventricular systolic (s') velocities, strain, tissue tracking and myocardial performance index. Plasma brain natriuretic peptide was also obtained within 24 hour. The influence of echocardiographic and clinical variables on mortality was examined (up to 12 months) using Cox regression analysis.
  
  
  RESULTS
  Out of 118 patients, 100 patients were included in the study (60 males, aged 55±17 years). Right ventricular dysfunction was observed in 28% using two-dimensional echocardiography. Tissue Doppler right ventricular variables (s' velocities, tissue tracking and strain) were decreased only for patients with right ventricular dysfunction, whereas myocardial performance index and systolic pulmonary artery pressure were increased. Mean brain natriuretic peptide value was 66±111pg/mL, also increased in patients with right ventricular dysfunction (136±146pg/mL). Mortality was 11% and related to age, malignancy and brain natriuretic peptide levels. The only echocardiographic variables capable of predicting events by univariate analysis were pulmonary pressure and right ventricular s' velocity. However, multivariate analysis showed only malignancy to predict mortality in this group.
  
  
  CONCLUSIONS
  Lower tissue Doppler systolic velocities and elevated brain natriuretic peptide levels are associated with poorer prognosis in patients with pulmonary thromboembolism; but only malignancy emerged as an independent predictor of mortality.
authors.forename: Ana Clara Tude
authors.initials: AC
authors.lastname: Rodrigues
authors.forename: Adriana
authors.initials: A
authors.lastname: Cordovil
authors.forename: Cláudia Gianini
authors.initials: CG
authors.lastname: Mônaco
authors.forename: Laise Antônia Bonfim
authors.initials: LA
authors.lastname: Guimarães
authors.forename: Wércules Antônio Alves de
authors.initials: WA
authors.lastname: Oliveira
authors.forename: Claudio Henrique
authors.initials: CH
authors.lastname: Fischer
authors.forename: Edgar Bezerra
authors.initials: EB
authors.lastname: de Lira-Filho
authors.forename: Marcelo Luiz Campos
authors.initials: ML
authors.lastname: Vieira
authors.forename: Samira Saady
authors.initials: SS
authors.lastname: Morhy
mesh_terms: D015415:Biomarkers / Q000097:blood; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D015588:Observer Variation; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000097:blood* / Q000000981:diagnostic imaging*; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging*
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain