title: N-terminal Pro-brain Natriuretic Peptide, High-sensitivity Troponin and Pulmonary Artery Clot Score as Predictors of Right Ventricular Dysfunction in Echocardiography.
abstract: BACKGROUND
  We investigated the ability of cardiac biomarkers and total pulmonary artery (PA) clot score to predict right ventricular dysfunction (RVD) on admission and at seven-month follow-up in subjects with acute pulmonary embolism (APE).
  
  
  METHODS
  Sixty-three normotensive patients with APE were divided into two groups: patients with (n= 32, age 58±19 years) and without (n=31, age 55±16 years) echocardiographic RVD. Transthoracic echocardiography (TTE), N-terminal pro-brain natriuretic peptide (NT-proBNP), and high-sensitivity troponin T (hsTnT) were assessed upon arrival and repeated at seven months. Total PA clot score was determined on admission.
  
  
  RESULTS
  The age- and sex dependent NT-proBNP on admission, on day 5, and at seven months exhibited the best sensitivity (admission 94%, day 5 100%, seven months 100%) and negative predictive value (NPV) (89%, 100%, 100%) for detecting RVD. Six patients (10%) had persistent RVD at seven months. Total PA clot score showed only low to moderate sensitivity (77%) and PPV (7%) for detection of RVD at seven months.
  
  
  CONCLUSIONS
  Normal age- and sex dependent NT-proBNP on admission or measured five days later seems to be useful in exclusion of RVD at follow up. Total PA clot score shows only to be of modest benefit for predicting persistent RVD.
authors.affiliation: Heart and Lung Center, Cardiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. Electronic address: marit.graner@hus.fi.
authors.forename: Marit
authors.initials: M
authors.lastname: Granér
authors.affiliation: Emergency Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Veli-Pekka
authors.initials: VP
authors.lastname: Harjola
authors.affiliation: Science Service Center, Kuopio University Hospital, Kuopio, Finland.
authors.forename: Tuomas
authors.initials: T
authors.lastname: Selander
authors.affiliation: Helsinki City Emergency Services, Helsinki Malmi City Hospital, Helsinki, Finland.
authors.forename: Mia K
authors.initials: MK
authors.lastname: Laiho
authors.affiliation: HUS Medical Imaging Center, Radiology, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Anneli
authors.initials: A
authors.lastname: Piilonen
authors.affiliation: HUS Medical Imaging Center, Radiology, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Merja
authors.initials: M
authors.lastname: Raade
authors.affiliation: Department of Medicine, Division of Cardiology, Keski-Suomi Central Hospital, Jyväskylä, Finland.
authors.forename: Pirjo
authors.initials: P
authors.lastname: Mustonen
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011651:Pulmonary Artery / Q000000981:diagnostic imaging*; D011655:Pulmonary Embolism / Q000097:blood / Q000000981:diagnostic imaging; D013927:Thrombosis / Q000097:blood / Q000000981:diagnostic imaging; D014336:Troponin / Q000097:blood*; D018497:Ventricular Dysfunction, Right / Q000097:blood / Q000000981:diagnostic imaging
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; D014336:Troponin; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: Cardiac biomarkers; Pulmonary artery clot score; Pulmonary embolism; Right ventricular dysfunction