OJEMD  Vol.2 No.4 , November 2012
Prognostic Value of N-Terminal Pro-Brain Natriuretic Peptide in Acute Pulmonary Embolism
Abstract: Patients with pulmonary embolism (PE) have a high risk of death and it is important to recognize factors associated with high mortality. N-Terminal pro-Brain Natriuretic Peptide (NT-pro BNP) has recently emerged as a promising biomarker for risk assessment in acute pulmonary embolism (PE). The aim of this study is to detect the in hospital prognostic value of NT-pro BNP in patients with acute (PE). Methods: This study included 64 patients diagnosed as (PE) with the mean age of 59.1 ± 16.5 years, 40 patients of them (62.5%) were male. All patients were subjected to 12 leads ECG. X-ray chest, laboratory tests including D-Dimer, troponin I, NT-pro BNP, Doppler ultrasound for the venous system of both lower limbs, Echocardiograhy and 64 multislices CT pulmonary angiography. Results: According to the admission level of NT-pro BNP our patients were divided into two groups: group I included 22 patients with normal NT-pro BNP (less than 300 pg/ml), and group II included 42 patients with elevated NT-pro BNP (more than or equal 300 pg/ml). Patients in group II were found to have a significantly higher incidence of heart failure (28.6% Vs 4.6%, p = 0.025), impaired kidney function (serum creatinine was 1.7 ± 0.6 Vs 1.1 ± 0.2, p = 0.018), tachypnea (85.7% Vs 54.5%, p = 0.006) and cardiogenic shock (26.2% Vs 0%, p = 0.014) but a significantly lower incidence of chest pain (21.4% Vs 45.5%, p = 0.04) and lower left ventricular ejection fraction (51.3% ± 16.9% Vs 67.3% ± 12.8%, p = 0.043) compared to group I. There were a significantly higher treatment with thrombolytic therapy (35.7% Vs 9.1%, p=0.021) and positive inotropics (35.71% Vs 4.55%, p = 0.006) in group II compared to group I. Also group II had a higher need for mechanical ventilation (26.12% Vs 4.55%, p = 0.04) and a longer in hospital stay (19.5 ± 10.3 Vs 5.3 ± 4.5, p = 0.001) than group I. The in hospital mortality was significantly higher in group II compared to group I (19.05% Vs 0.0%, p = 0.042). Conclusion: Elevated NT-pro BNP levels in patients with (PE) are associated with worse short term prognosis in terms of higher morbidity and mortality and it could be used as a valuable prognostic parameter and good indicator for the need of more aggressive therapy.
Cite this paper: A. Selem, H. Radwan and A. M Gomaa, "Prognostic Value of N-Terminal Pro-Brain Natriuretic Peptide in Acute Pulmonary Embolism," Open Journal of Endocrine and Metabolic Diseases, Vol. 2 No. 4, 2012, pp. 58-62. doi: 10.4236/ojemd.2012.24009.

[1]   J. A. Heit, L. J. Melton, C. M. Lohse, T. M. Petterson, M. D. Silverstein, D. N. Mohr and W. M. O’Fallon, “Incidence of Venous Thromboembolism in Hospitalized Patients Vs Community Residents,” Mayo Clinic Proceedings, 2001, pp. 1102-1110. doi:10.4065/76.11.1102

[2]   C. Kearon, “Natural History of Venous Thromboembolism,” Circulation, Vol. 107, No. 23 S1, 2003, pp. 22-30. doi:10.1161/01.CIR.0000078464.82671.78

[3]   S. Z. Goldhaber, L. Visani and M. De Rosa, “Acute Pulmonary Embolism: Clinical Outcomes in the International Cooperative Pulmonary Embolism Registery,” Lancet, Vol. 353, No. 9162, 1999, pp. 1386-1389. doi:10.1016/S0140-6736(98)07534-5

[4]   S. Konstantinides, “Pulmonary Embolism: Impact of Right Ventricular Dysfunction,” Current Opinion on Cardiology, Vol. 20, No. 6, 2005, pp. 496-501. doi:10.1097/

[5]   S. Z. Glodhabber, “Pulmonary Embolism. Braunwald s Heart Disease A Textbook of Cardiovascular Medicine,” 9th Edition, Saunders, 2012.

[6]   S. Z. Goldhaber, “Pulmonary Embolism,” Lancet, Vol. 363, No. 9417, 2004, pp. 1295-1305. doi:10.1016/S0140-6736(04)16004-2

[7]   R. Cavallazzi, A. Nair, T. Vasu and P. E. Marik, “Natriuretic Peptides in Acute Pulmonary Embolism: A Systematic Review Published Online,” Vol. 34, No. 12, 2008, pp. 2147-2156.

[8]   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, Vol. 112, No. 11, 2005, pp. 1573-1579. doi:10.1161/CIRCULATIONAHA.105.552216

[9]   N. Vuilleumier, M. Righini, A. Perrier, A. Rosset, N. Turck, J. C. Sanchez, H. Bounameaux, G. Le Gal, N. Mensi and D. Hochstrasser, “Correlation between Cardiac Biomarkers and Right Ventricular Enlargement on Chest CT in Non Massive Pulmonary Embolism,” Thombo Research, Vol. 121, No. 5, 2008, pp. 617-624. doi:10.1016/j.thromres.2007.07.003

[10]   N. Kucher, G. Printzen and S. Z. Goldhaber, “Prognostic Role of Brain Natriuretic Peptide in Acute Pulmonary Embolism,” Circulation, Vol. 107, No. 20, 2003, pp. 2545-2547. doi:10.1161/01.CIR.0000074039.45523.BE

[11]   W. Kasper, S. Konstantinides, A. Geibel, M. Olschewski, F. Heinrich, K. D. Grosser, K. Rauber, S. Iversen, M. Redecker and J. Kienast, “Management Strategies and Determinants of Outcome in Acute Major Pulmonary Embolism: Results of a Multicenter Registry,” Journal of American College Cardiology, Vol. 30, No. 5, 1997, pp. 1165-1171. doi:10.1016/S0735-1097(97)00319-7

[12]   “British Thoracic Society Guidelines for the Management of Suspected Acute Pulmonary Embolism,” Thorax, Vol. 58, No. 6, 2003, pp. 470-483. doi:10.1136/thorax.58.6.470

[13]   H. Dores, C. Fonseca, S. Leal, I. Rosário, J. Abecasis, J. Monge, M. J. Correia, L. Bronze, A. Leit?o, I. Arroja, A. Aleixo and A. Silva, “NT-proBNP for Risk Stratification of Pulmonary Embolism,” Portuguese Journal of Cardiology, Vol. 30, No. 12, 2011, pp. 881-886.

[14]   J. C. Lega, Y. Lacasse, L. Lakhal and S. Provencher, “Natriuretic Peptides and Troponins in Pulmonary Embolism: A Meta-Analysis,” Thorax, Vol. 64, No. 10, 2009, pp. 869-875. doi:10.1136/thx.2008.110965

[15]   M. J. Agterof, R. E. Schutgens, R. J. Snijder, G. Epping, H. G. Peltenburg, E. F. Posthuma, J. A. Hardeman, R. van der Griend, T. Koster, M. H. Prins and D. H. Biesma, “Out of Hospital Treatment of Acute Pulmonary Embolism in Patients with a Low NT-proBNP Level,” Journal of Thromb Haemost, Vol. 8, No. 6, 2010, pp. 1235-1241. doi:10.1111/j.1538-7836.2010.03831.x

[16]   Columbus Investigators, “Low-Molecular-Weight Heparin in the Treatment of Patients with Venous Thromboembolism,” New England Journal of Medicine, 1997, Vol. 337, No. 10, pp. 657-662. doi:10.1056/NEJM199709043371001

[17]   J. H. Beer, M. Burger, S. Gretener, S. Bernard-Bagattini, H. Bounameaux, “Outpatient Treatment of Pulmonary Embolism Is Feasible and Safe in a Substantial Proportion of Patients,” Journal of Thromb Haemost, 2003, Vol. 1, No. 1, pp. 186-187. doi:10.1046/j.1538-7836.2003.00005.x

[18]   S. Konstantinides, A. Geibel, G. Heusel, F. Heinrich and W. Kasper, “Management Strategies and Prognosis of Pulmonary Embolism-3 Trial Investigators. Heparin Plus Alteplase Compared with Heparin Alone in Patients with Submassive Pulmonary Embolism,” New England Journal of Medicine, Vol. 347, No. 15, 2002, pp. 1143-1150. doi:10.1056/NEJMoa021274

[19]   T. Schmitz-Rode, U. Janssens, S. H. Duda, C. M. Erley and R. W. Günther, “Massive Pulmonary Embolism: Percutaneous Emergency Treatment by Pigtail Rotation Catheter,” Journal of American College Cardiology, Vol. 36, No. 2, 2000, pp. 375-380. doi:10.1016/S0735-1097(00)00734-8

[20]   L. Aklog, C. S. Williams, J. G. Byrne and S. Z. Goldhaber, “Acute Pulmonary Embolectomy: A Contemporary Approach,” Circulation, 2002, Vol. 105, No. 12, pp. 1416-1419. doi:10.1161/01.CIR.0000012526.21603.25

[21]   M. Kostrubiec, P. Pruszczyk, A. Kaczynska and N. Kucher, “Persistent NT-proBNP Elevation in Acute Pulmonary Embolism Predicts Early Death,” Clinica Chimica Acta, 2007, Vol. 382, No. 1-2, pp. 124-128. doi:10.1016/j.cca.2007.04.010