on May 12, 2003
Circulation. 2003
Published online before print May 12, 2003, doi: 10.1161/01.CIR.0000074039.45523.BE
Published online before print May 12, 2003, doi: 10.1161/01.CIR.0000074039.45523.BE
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Submitted on March 13, 2003
From the Cardiovascular Division (N.K., S.Z.G.), Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; and the Department of Clinical Chemistry (G.P.), University Hospital Bern, Switzerland. * To whom correspondence should be addressed. E-mail: sgoldhaber{at}partners.org.
Background--Rapid, noninvasive, and accurate prognostic assessment with an inexpensive cardiac biomarker is an appealing approach for patients with acute pulmonary embolism (PE). Methods and Results--We measured at the time of admission the plasma level of plasma brain natriuretic peptide (BNP) to determine its utility in prognosticating the clinical course of 73 consecutive patients with acute PE. We used a prespecified BNP cut-off level (<90 pg/mL) for the prediction of the absence of a major adverse cardiovascular event, defined as any of the following: death, cardiopulmonary resuscitation, mechanical ventilation, or use of pressors, thrombolysis, catheter fragmentation, or surgical embolectomy. In the 20 (27%) patients with adverse events, median BNP (194.2, range 3.7 to 1201.1 pg/mL) was higher than in patients with a benign course (39.1, range 1.0 to 1560.0 pg/mL; P<0.001). However, 3 patients with adverse outcomes had low BNP levels on admission: 1 death, BNP 52 pg/mL; 1 patient with prolonged cardiopulmonary resuscitation, BNP 3.7 pg/mL; and 1 patient undergoing rescue thrombolysis, BNP 75 pg/mL. Sensitivity, specificity, and negative and positive predictive value of BNP levels <90 pg/mL for absence of adverse outcomes were 85% (64% to 95%), 75% (62% to 85%), 93% (95% CI 81% to 98%), and 57% (39% to 73%), respectively. The optimal BNP cut-off level, identified by receiver operating characteristic analysis, was <50 pg/mL. Conclusions--Low BNP levels do not guarantee an uncomplicated hospital course in patients with acute PE, using a "congestive heart failure" cut-off level of 90 pg/mL. A lower cut-off level of <50 pg/mL identifies 95% of patients with a benign clinical course.
Revised on April 10, 2003
Accepted on April 11, 2003
Prognostic Role of Brain Natriuretic Peptide in Acute Pulmonary Embolism
Nils Kucher MD,
Key words: natriuretic peptides • heart diseases • prognosis • embolism • thrombosis
This article has been cited by other articles:
 |
|
 |
|
  J-C Lega, Y Lacasse, L Lakhal, and S Provencher Natriuretic peptides and troponins in pulmonary embolism: a meta-analysis Thorax, October 1, 2009; 64(10): 869 - 875. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. L. Todd and V. F. Tapson Thrombolytic Therapy for Acute Pulmonary Embolism: A Critical Appraisal Chest, May 1, 2009; 135(5): 1321 - 1329. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Authors/Task Force Members, A. Torbicki, A. Perrier, S. Konstantinides, G. Agnelli, N. Galie, P. Pruszczyk, F. Bengel, A. J.B. Brady, D. Ferreira, et al. Guidelines on the diagnosis and management of acute pulmonary embolism: The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC) Eur. Heart J., September 2, 2008; 29(18): 2276 - 2315. [Full Text] [PDF]
|
|
|
|
 |
|
 A. Maisel, C. Mueller, K. Adams Jr., S. D. Anker, N. Aspromonte, J. G.F. Cleland, A. Cohen-Solal, U. Dahlstrom, A. DeMaria, S. Di Somma, et al. State of the art: Using natriuretic peptide levels in clinical practice Eur J Heart Fail, September 1, 2008; 10(9): 824 - 839. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. A. Klok, I. C. M. Mos, and M. V. Huisman Brain-Type Natriuretic Peptide Levels in the Prediction of Adverse Outcome in Patients with Pulmonary Embolism: A Systematic Review and Meta-analysis Am. J. Respir. Crit. Care Med., August 15, 2008; 178(4): 425 - 430. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Warwick, P. S. Thomas, and D. H. Yates Biomarkers in pulmonary hypertension Eur. Respir. J., August 1, 2008; 32(2): 503 - 512. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
O. Sanchez, L. Trinquart, I. Colombet, P. Durieux, M. V. Huisman, G. Chatellier, and G. Meyer Prognostic value of right ventricular dysfunction in patients with haemodynamically stable pulmonary embolism: a systematic review Eur. Heart J., June 2, 2008; 29(12): 1569 - 1577. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Jimenez, G. Diaz, J. Molina, D. Marti, J. Del Rey, S. Garcia-Rull, C. Escobar, R. Vidal, A. Sueiro, and R. D. Yusen Troponin I and risk stratification of patients with acute nonmassive pulmonary embolism Eur. Respir. J., April 1, 2008; 31(4): 847 - 853. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. T. Lu, T. Cai, H. Ersoy, A. G. Whitmore, R. Quiroz, S. Z. Goldhaber, and F. J. Rybicki Interval Increase in Right-Left Ventricular Diameter Ratios at CT as a Predictor of 30-day Mortality after Acute Pulmonary Embolism: Initial Experience Radiology, January 1, 2008; 246(1): 281 - 287. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. B. Daniels and A. S. Maisel Natriuretic Peptides J. Am. Coll. Cardiol., December 18, 2007; 50(25): 2357 - 2368. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J.G. Coghlan and J. Davar How should we assess right ventricular function in 2008? Eur. Heart J. Suppl., December 1, 2007; 9(suppl_H): H22 - H28. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. G. Stevinson, J. Hernandez-Nino, G. Rose, and J. A. Kline Echocardiographic and functional cardiopulmonary problems 6 months after first-time pulmonary embolism in previously healthy patients Eur. Heart J., October 2, 2007; 28(20): 2517 - 2524. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Becattini, M. C. Vedovati, and G. Agnelli Prognostic Value of Troponins in Acute Pulmonary Embolism: A Meta-Analysis Circulation, July 24, 2007; 116(4): 427 - 433. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. J. Carlbom and B. L. Davidson Pulmonary Embolism in the Critically Ill Chest, July 1, 2007; 132(1): 313 - 324. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Bergler-Klein, G. Mundigler, P. Pibarot, I. G. Burwash, J. G. Dumesnil, C. Blais, C. Fuchs, D. Mohty, R. S. Beanlands, Z. Hachicha, et al. B-Type Natriuretic Peptide in Low-Flow, Low-Gradient Aortic Stenosis: Relationship to Hemodynamics and Clinical Outcome: Results From the Multicenter Truly or Pseudo-Severe Aortic Stenosis (TOPAS) Study Circulation, June 5, 2007; 115(22): 2848 - 2855. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S.P. Schoen, T. Zimmermann, T. Kittner, M.U. Braun, J. Fuhrmann, A. Schmeisser, and R.H. Strasser NT-proBNP correlates with right heart haemodynamic parameters and volumes in patients with atrial septal defects Eur J Heart Fail, June 1, 2007; 9(6-7): 660 - 666. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C-H Huang, M-S Tsai, C-C Hsieh, T-D Wang, W-T Chang, and W-J Chen Diagnostic accuracy of tissue Doppler echocardiography for patients with acute heart failure Heart, December 1, 2006; 92(12): 1790 - 1794. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Abroug, L. Ouanes-Besbes, N. Nciri, N. Sellami, F. Addad, K. B. Hamda, A. B. Amor, M. F. Najjar, and J. Knani Association of Left-Heart Dysfunction with Severe Exacerbation of Chronic Obstructive Pulmonary Disease: Diagnostic Performance of Cardiac Biomarkers Am. J. Respir. Crit. Care Med., November 1, 2006; 174(9): 990 - 996. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Clerico, F. A. Recchia, C. Passino, and M. Emdin Cardiac endocrine function is an essential component of the homeostatic regulation network: physiological and clinical implications Am J Physiol Heart Circ Physiol, January 1, 2006; 290(1): H17 - H29. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. Kucher, R. Quiroz, S. McKean, A. A Sasahara, and S. Z Goldhaber Extended enoxaparin monotherapy for acute symptomatic pulmonary embolism Vascular Medicine, November 1, 2005; 10(4): 251 - 256. [Abstract] [PDF]
|
|
|
|
|
|
M. Kostrubiec, P. Pruszczyk, A. Bochowicz, R. Pacho, M. Szulc, A. Kaczynska, G. Styczynski, A. Kuch-Wocial, P. Abramczyk, Z. Bartoszewicz, et al. Biomarker-based risk assessment model in acute pulmonary embolism Eur. Heart J., October 2, 2005; 26(20): 2166 - 2172. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. H. Leuchte, M. Holzapfel, R. A. Baumgartner, C. Neurohr, M. Vogeser, and J. Behr Characterization of Brain Natriuretic Peptide in Long-term Follow-up of Pulmonary Arterial Hypertension Chest, October 1, 2005; 128(4): 2368 - 2374. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Giannitsis and H. A. Katus Risk Stratification in Pulmonary Embolism Based on Biomarkers and Echocardiography Circulation, September 13, 2005; 112(11): 1520 - 1521. [Full Text] [PDF]
|
|
|
|
|
|
L. Binder, B. Pieske, M. Olschewski, A. Geibel, B. Klostermann, C. Reiner, and S. Konstantinides N-Terminal Pro-Brain Natriuretic Peptide or Troponin Testing Followed by Echocardiography for Risk Stratification of Acute Pulmonary Embolism Circulation, September 13, 2005; 112(11): 1573 - 1579. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Piazza and S. Z. Goldhaber The Acutely Decompensated Right Ventricle: Pathways for Diagnosis and Management Chest, September 1, 2005; 128(3): 1836 - 1852. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. M. McKie and J. C. Burnett Jr B-Type Natriuretic Peptide as a Biomarker Beyond Heart Failure: Speculations and Opportunities Mayo Clin. Proc., August 1, 2005; 80(8): 1029 - 1036. [Abstract] [PDF]
|
|
|
|
|
|
R. W. van der Meer, P. M. T. Pattynama, M. J. L. van Strijen, A. A. van den Berg-Huijsmans, I. J. C. Hartmann, H. Putter, A. de Roos, and M. V. Huisman Right Ventricular Dysfunction and Pulmonary Obstruction Index at Helical CT: Prediction of Clinical Outcome during 3-month Follow-up in Patients with Acute Pulmonary Embolism Radiology, June 1, 2005; 235(3): 798 - 803. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. B. Yap, D. Mukerjee, P. M. Timms, H. Ashrafian, and J. G. Coghlan Natriuretic Peptides, Respiratory Disease, and the Right Heart Chest, October 1, 2004; 126(4): 1330 - 1336. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. H. Leuchte, C. Neurohr, R. Baumgartner, M. Holzapfel, W. Giehrl, M. Vogeser, and J. Behr Brain Natriuretic Peptide and Exercise Capacity in Lung Fibrosis and Pulmonary Hypertension Am. J. Respir. Crit. Care Med., August 15, 2004; 170(4): 360 - 365. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Kemp, J. Donovan, H. Higham, and J. Hooper Biochemical markers of myocardial injury Br. J. Anaesth., July 1, 2004; 93(1): 63 - 73. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L La Vecchia, F Ottani, L Favero, G L Spadaro, A Rubboli, C Boanno, G Mezzena, A Fontanelli, and A S Jaffe Increased cardiac troponin I on admission predicts in-hospital mortality in acute pulmonary embolism Heart, June 1, 2004; 90(6): 633 - 637. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Bergler-Klein, U. Klaar, M. Heger, R. Rosenhek, G. Mundigler, H. Gabriel, T. Binder, R. Pacher, G. Maurer, and H. Baumgartner Natriuretic Peptides Predict Symptom-Free Survival and Postoperative Outcome in Severe Aortic Stenosis Circulation, May 18, 2004; 109(19): 2302 - 2308. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P Pruszczyk, M Szulc, and M Kostrubiec Potential clinical application of brain natriuretic peptides in acute pulmonary embolism Eur. Heart J., April 1, 2004; 25(7): 621 - 621. [Full Text] [PDF]
|
|
|
|
 |
|
 A. Clerico and M. Emdin Diagnostic Accuracy and Prognostic Relevance of the Measurement of Cardiac Natriuretic Peptides: A Review Clin. Chem., January 1, 2004; 50(1): 33 - 50. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Z. Goldhaber and C. G. Elliott Acute Pulmonary Embolism: Part II: Risk Stratification, Treatment, and Prevention Circulation, December 9, 2003; 108(23): 2834 - 2838. [Full Text] [PDF]
|
|
|
|
|
|
S. Z. Goldhaber and C. G. Elliott Acute Pulmonary Embolism: Part I: Epidemiology, Pathophysiology, and Diagnosis Circulation, December 2, 2003; 108(22): 2726 - 2729. [Full Text] [PDF]
|
|
|
|
|
|
N. Kucher and S. Z. Goldhaber Cardiac Biomarkers for Risk Stratification of Patients With Acute Pulmonary Embolism Circulation, November 4, 2003; 108(18): 2191 - 2194. [Full Text] [PDF]
|
|
|
|
|
|
H. Smithline, N. Kucher, G. Printzen, T. Doernhoefer, S. Windecker, B. Meier, and O. M. Hess Use of Natriuretic Peptides in Guiding Treatment Decisions for Acute Pulmonary Embolism * Response Circulation, September 30, 2003; 108 (13): e93 - e93. [Full Text] [PDF]
|
|
|
|
|
|
S. Kruger, M. W. Merx, J. Graf, G. Thabut, D. Logeart, N. Kucher, G. Printzen, T. Doernhoefer, S. Windecker, B. Meier, et al. Utility of Brain Natriuretic Peptide to Predict Right Ventricular Dysfunction and Clinical Outcome in Patients With Acute Pulmonary Embolism * Response Circulation, September 30, 2003; 108 (13): e94 - e95. [Full Text] [PDF]
|
|
|
|
 |
|
 Low BNP Level Does Not Rule Out Complicated PE Journal Watch Emergency Medicine, July 15, 2003; 2003(715): 7 - 7. [Full Text]
|
|