Circulation. 2003;107:1576-1578
Published online before print March 24, 2003, doi: 10.1161/01.CIR.0000064898.51892.09
Published online before print March 24, 2003, doi: 10.1161/01.CIR.0000064898.51892.09
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(Circulation. 2003;107:1576.)
© 2003 American Heart Association, Inc.
Brief Rapid Communications |
Low Pro-Brain Natriuretic Peptide Levels Predict Benign Clinical Outcome in Acute Pulmonary Embolism
From the Swiss Cardiovascular Center, Cardiology (N.K., S.W., B.M., O.M.H.), the Department of Clinical Chemistry (G.P.), and the Department of Radiology (T.D.), University Hospital, Bern, Switzerland.
Correspondence to Nils Kucher, MD, Cardiology, VTE Research Group, Brigham and Women‘s Hospital, Harvard Medical School, 75 Francis St, 4th floor, Boston, MA 02115. E-mail nkucher{at}partners.org
Background— The role of pro-brain natriuretic peptide (proBNP) for the prediction of clinical outcome has not been examined in patients with acute pulmonary embolism (PE).
Methods and Results— ProBNP levels were measured in 73 patients with acute PE within 4 hours of admission. Adverse clinical outcome was defined as in-hospital death or the need for at least 1 of the following: cardiopulmonary resuscitation, mechanical ventilation, pressors, thrombolysis, catheter fragmentation, or surgical embolectomy. In the 53 patients with a benign clinical outcome, proBNP (median 121, range 16 to 34 802 pg/mL) was lower than in 20 patients with adverse clinical outcome (median 4250, range 92 to 49 607 pg/mL; P<0.0001). The negative predictive value of proBNP levels <500 pg/mL to predict adverse clinical outcome was 97% (95% confidence interval 84 to 99). ProBNP remained an independent predictor for adverse clinical outcome (odds ratio 14.6; 95% confidence interval 1.5 to 139.0; P=0.02) after adjusting for severity of PE (submassive/massive), troponin T levels >0.01ng/mL, age >70 years, gender, and history of congestive heart failure.
Conclusions— Low proBNP levels predict an uneventful hospital course in patients with acute PE. A proBNP level <500 pg/mL identifies patients who will be potential candidates for an abbreviated hospital length of stay or care on a completely outpatient basis.
Key Words: natriuretic peptides • pulmonary heart disease • prognosis
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|
|
|
|
 |
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|
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|
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|
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|
|
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|
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|
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|
|
|
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|
|
|
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|
|