NT-pro-BNP levels in patients with acute pulmonary embolism are correlated to right but not left ventricular volume and function.
Summary of "NT-pro-BNP levels in patients with acute pulmonary embolism are correlated to right but not left ventricular volume and function."
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.
Affiliation
S. M. Pasha, Leiden University Medical Center, Albinusdreef 2, Postzone C4-70, 2333 ZA Leiden, The Netherlands, E-mail: s.m.pasha@lumc.nl.
Journal Details
This article was published in the following journal.
Name: Thrombosis and haemostasis
ISSN: 0340-6245
Pages:
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/22740123
- DOI: http://dx.doi.org/10.1160/TH11-12-0901
Medical and Biotech [MESH] Definitions
Acute Chest Syndrome
Respiratory syndrome characterized by the appearance of a new pulmonary infiltrate on chest x-ray, accompanied by symptoms of fever, cough, chest pain, tachypnea, or DYSPNEA, often seen in patients with SICKLE CELL ANEMIA. Multiple factors (e.g., infection, and pulmonary FAT EMBOLISM) may contribute to the development of the syndrome.
Pulmonary Heart Disease
Hypertrophy and dilation of the RIGHT VENTRICLE of the heart that is caused by PULMONARY HYPERTENSION. This condition is often associated with pulmonary parenchymal or vascular diseases, such as CHRONIC OBSTRUCTIVE PULMONARY DISEASE and PULMONARY EMBOLISM.
Pulmonary Embolism
Blocking of the PULMONARY ARTERY or one of its branches by an EMBOLUS.
Quinolinic Acid
A metabolite of tryptophan with a possible role in neurodegenerative disorders. Elevated CSF levels of quinolinic acid are correlated with the severity of neuropsychological deficits in patients who have AIDS.
Protein S Deficiency
An autosomal dominant disorder showing decreased levels of plasma protein S antigen or activity, associated with venous thrombosis and pulmonary embolism. PROTEIN S is a vitamin K-dependent plasma protein that inhibits blood clotting by serving as a cofactor for activated PROTEIN C (also a vitamin K-dependent protein), and the clinical manifestations of its deficiency are virtually identical to those of protein C deficiency. Treatment with heparin for acute thrombotic processes is usually followed by maintenance administration of coumarin drugs for the prevention of recurrent thrombosis. (From Harrison's Principles of Internal Medicine, 12th ed, p1511; Wintrobe's Clinical Hematology, 9th ed, p1523)
PubMed Articles
To the Editor: In their review article, Agnelli and Becattini (July 15 issue)(1) discuss many important topics in acute pulmonary embolism. We would like to highlight the importance of the use of pulm...
To the Editor: In their review article, Agnelli and Becattini (July 15 issue)(1) discuss many important topics in acute pulmonary embolism. We would like to highlight the importance of the use of pulm...
To the Editor: In their review article, Agnelli and Becattini (July 15 issue)(1) discuss many important topics in acute pulmonary embolism. We would like to highlight the importance of the use of pulm...
To the Editor: In their review article, Agnelli and Becattini (July 15 issue)(1) discuss many important topics in acute pulmonary embolism. We would like to highlight the importance of the use of pulm...
To the Editor: In their review article, Agnelli and Becattini (July 15 issue)(1) discuss many important topics in acute pulmonary embolism. We would like to highlight the importance of the use of pulm...
Clinical Trials
Post-marketing Study of Monteplase ("Cleactor") in Patients With Acute Pulmonary Embolism
To investigate PK and coagulating and fibrinolytic parameter profiles (PD) at the approved dose (13,750 - 27,500 IU/kg) in patients with acute pulmonary embolism accompanying hemodynamic i...
Identifying Low-Risk Patients With Pulmonary Embolism
To develop a clinical prediction rule to identify patients with acute pulmonary embolism who are at very low risk for short-term adverse outcomes.
To assess the safety and efficacy of outpatient treatment using fondaparinux and oral Vit K antagonist, warfarin (Coumadin) in patients with stable acute pulmonary embolus (APE)when initia...
Tinzaparin in the Treatment of the Acute Pulmonary Embolism
The purpose of this study is to evaluate the feasibility of the long-term treatment of pulmonary embolism with tinzaparin compared to oral anticoagulants.
The aim of this study is to investigate the safety of treatment of pulmonary embolism in an outpatient setting based on normal pro-BNP levels. The mortality rate and the incidence of hemod...
