Simultaneous measurement of serum cTnT and NT-proBNP allows for precise APE prognosis. Normotensive patients on admission with cTnT> or =0.07 microg/L and NT-proBNP> or =600 ng/L are at high risk of APE mortality, whereas NTproBNP<600 ng/L indicates excellent prognosis.

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Plasma brain natriuretic peptide (BNP), released from myocytes of ventricles upon stretch, has been reported to differentiate pulmonary from cardiac dyspnoea. Limited data have shown elevated plasma BNP levels in acute pulmonary embolism (APE), frequently accompanied by dyspnoea and right ventricular (RV) dysfunction. The aim of this study was to assess plasma N-terminal proBNP (NTproBNP) in APE, and to establish whether it reflects the severity of RV overload and if it can be used to predict adverse clinical outcome.On admission, NT-proBNP and echocardiography for RV overload were performed in 79 APE patients (29 males), aged 63¡16 yrs.Plasma NT-proBNP was elevated in 66 patients (83.5%) and was higher in patients with (median 4,650 pg?mL -1 (range 61-60,958)) than without RV strain (363 pg?mL -1 329)). RV-to-left ventricular ratio and inferior vena cava dimension correlated with NT-proBNP. All 15 in-hospital deaths and 24 serious adverse events occurred in the group with elevated NT-proBNP, while all 13 (16.5%) patients with normal values had an uncomplicated clinical course. Plasma NT-proBNP predicted in-hospital mortality. Plasma N-terminal pro-brain natriuretic peptide is elevated in the majority of cases of pulmonary embolism resulting in right ventricular overload. Plasma levels reflect the degree of right ventricular overload and may help to predict short-term outcome. Acute pulmonary embolism should be considered in the differential diagnosis of patients with dyspnoea and abnormal levels of brain natriuretic peptide. Eur Respir J 2003; 22: 649-653. Elevated plasma levels of brain natriuretic peptide (BNP) released from myocytes of ventricles upon stretch have been found in patients with congestive heart failure and even in those with asymptomatic left ventricular (LV) systolic dysfunction [1,2]. Moreover, elevated plasma BNP was found in patients with primary pulmonary hypertension and chronic thromboembolic pulmonary hypertension [3,4]. Interestingly, elevated plasma BNP was reported to help differentiate pulmonary from cardiac aetiologies of acute dyspnoea [5]. Plasma N-terminal proBNP (NT-proBNP) is also increased in congestive heart failure patients [6] and it may help to stratify their prognosis [7,8]. However, limited data suggest that plasma BNP may be elevated in patients with acute pulmonary embolism (APE), frequently accompanied by acute dyspnoea and right ventricular (RV) dysfunction [9][10][11]. Therefore, the aim of this study was to assess plasma levels of NT-proBNP in patients with APE, and to establish whether the levels reflect the severity of RV overload and whether they can be used to predict adverse clinical outcome. Materials and methods Clinical dataThe study analysed consecutive patients with symptomatic APE. APE was confirmed by contrast-enhanced spiral computed tomography or by high-probability lung scintigraphy according to PIOPED (Prospective Investigation of Pulmonary Embolism Diagnosis) criteria [12]. On admission, systemic blood pressure (BP) and cardiac frequency...

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