Biomarker-based strategy for screening right ventricular dysfunction in patients with non-massive pulmonary embolism

Logeart, Damien; Lécuyer, Lucien; Thabut, Gabriel; Tabet, Jean-Yves; Tartière, Jean-Michel; Chavelas, Christophe; Bonnin, F.; Stievenart, J.L.; Solal, Alain Cohen

doi:10.1007/s00134-006-0482-1

Cited by 72 publications

(52 citation statements)

References 33 publications

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“…6,[9][10][11][12] For prediction of the development of a complicated clinical course, the optimal BNP cutoff value was 300 pg/mL, which was also consistent with the cutoff values selected by previous studies (range, 50 to 487 pg/ mL). 6,8,10,12,13) For prediction of the requirement for HOT at/after discharge, the optimal BNP cutoff value was 350 pg/mL, and this study was the first, to the best of our knowledge, to analyze the correlation between the plasma BNP and the potential requirement for HOT in patients with acute PE. These results indicate that we should carefully follow-up the respiratory condition in patients with high plasma levels of BNP at admission, and assess for the need of HOT at/after discharge.…”

Section: Discussionsupporting

confidence: 85%

“…A substantial body of evidence in the literature has demonstrated the value of measurement of plasma troponins and BNP and its N-terminal fragment for risk stratification of patients with PE. 6,[7][8][9][10][11][12][13][14][15][16] It is believed that the RV releases these peptides as a result of subendocardial ischemia and intramural mechanical strain caused by impedance to RV ejection posed by the PE. In this study, a good correlation (r = 0.824, P = 0.0003) was observed between the RV-right atrial pressure gradient and the plasma level of BNP.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of Biomarkers for Predicting Disease Severity and Long-Term Respiratory Prognosis in Patients With Acute Pulmonary Embolism

et al. 2010

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SummaryBiomarkers are needed for early risk stratification and improved inpatient management to obtain better outcomes in acute pulmonary embolism (PE) patients. The aim of the present study was to evaluate biomarkers of right ventricular dysfunction (RVD) in order to predict a complicated clinical course and long-term respiratory complications in acute PE.We retrospectively enrolled 50 consecutive patients hospitalized for acute PE. Plasma brain natriuretic peptide (BNP), troponin-I, fibrin degradation products, D-dimer, C-reactive protein, and arterial pH were measured to assess their prognostic significance. RVD was evaluated by echocardiography at admission, the clinical course during hospitalization was monitored for the development of complications (death, cardiopulmonary resuscitation, mechanical ventilation or circulatory shock), and the need for home oxygen therapy (HOT) was assessed at/after discharge.Thirty-two patients (64%) had RVD at admission, 6 (12%) developed a complicated clinical course, and 7 (14%) required HOT. Plasma BNP was significantly higher in patients with RVD (median value, 319.3 versus 50.5 pg/mL, P = 0.001). Plasma BNP was also significantly higher (median value, 1307.9 versus 102.6 pg/mL, P = 0.02) and arterial pH significantly lower (acidic) (median value, 7.371 versus 7.438, P = 0.008) in patients who developed a complicated clinical course. In addition, plasma BNP was also significantly higher in patients who required HOT (median value, 505.1 versus 91.1 pg/mL, P = 0.02).Plasma BNP at admission is not only a reliable marker of RVD and predictor of short-term prognosis, but also a predictor of long-term respiratory prognosis in acute PE patients. (Int Heart J 2010; 51: 416-420)

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Comparison of Biomarkers for Predicting Disease Severity and Long-Term Respiratory Prognosis in Patients With Acute Pulmonary Embolism

et al. 2010

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“…In contrast to the majority of studies enrolling younger hemodynamically stable patients with PE [13,15,20,21,[24][25][26][27][28][29][30], we did not find a relationship between echocardiographic RV dysfunction and short-term clinical outcomes in our sample of elderly patients. In particular, the specific set of echocardiographic criteria recommended by the American Heart Association (presence of RV/LV end-diastolic diameter ratio >0.9 or RV hypokinesis) was not associated with adverse clinical events.…”

Section: Discussioncontrasting

confidence: 99%

Echocardiography does not predict mortality in hemodynamically stable elderly patients with acute pulmonary embolism

Hofmann

Limacher

Méan

et al. 2016

Thrombosis Research

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“…A diagnosis of RV dysfunction was established in the presence of two or more of these criteria [21,22]. In addition, if bulging of the interventricular septum into the LV was observed, RVD was classified as severe [22,23]. All other forms of RVD were classified as moderate.…”

Section: Study Populationmentioning

confidence: 99%

Pulmonary embolism: CT signs and cardiac biomarkers for predicting right ventricular dysfunction

et al. 2011

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The aim of this study was to prospectively evaluate the accuracy of quantitative cardiac computed tomography (CT) parameters and two cardiac biomarkers (N-terminal-pro-brain natriuretic peptide (NT-pro-BNP) and troponin I), alone and in combination, for predicting right ventricular dysfunction (RVD) in patients with acute pulmonary embolism.557 consecutive patients with suspected pulmonary embolism underwent pulmonary CT angiography. Patients with pulmonary embolism also underwent echocardiography and NT-pro-BNP/troponin I serum level measurements. Three different CT measurements were obtained (right ventricular (RV)/left ventricular (LV)axial, RV/LV4-CH and RV/LVvolume). CT measurements and NTpro-BNP/troponin I serum levels were correlated with RVD at echocardiography.77 patients with RVD showed significantly higher RV/LV ratios and NT-pro-BNP/troponin I levels compared to those without RVD (RV/LVaxial 1.

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Biomarker-based strategy for screening right ventricular dysfunction in patients with non-massive pulmonary embolism

Abstract: In hemodynamically stable pulmonary embolism, BNP/troponin I measurement is helpful on admission, especially for ruling out RVD, i.e. patients with in-hospital high-risk.

Cited by 72 publications

References 33 publications

Comparison of Biomarkers for Predicting Disease Severity and Long-Term Respiratory Prognosis in Patients With Acute Pulmonary Embolism

Comparison of Biomarkers for Predicting Disease Severity and Long-Term Respiratory Prognosis in Patients With Acute Pulmonary Embolism

Echocardiography does not predict mortality in hemodynamically stable elderly patients with acute pulmonary embolism

Pulmonary embolism: CT signs and cardiac biomarkers for predicting right ventricular dysfunction

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