Brain Natriuretic Peptide as a Predictor of Adverse Outcome in Patients With Pulmonary Embolism

Wolde, M. Ten; Tulevski, Igor I.; Mulder, Jasper W.M.; Söhne, Maaike; Boomsma, Frans; Mulder, Barbara J.M.; Büller, Harry R.

doi:10.1161/01.cir.0000070020.79932.db

Cited by 242 publications

(114 citation statements)

References 14 publications

(14 reference statements)

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“…Studies (33)(34) have also shown that significant BNP elevations can occur in acute pulmonary embolism without any evidence of LV heart failure. In addition, elevation of BNP has prognostic importance in pulmonary embolism; in one study (33), a BNP level of less than 21.7 pg/mmol excluded fatal pulmonary embolism with 99% accuracy, while a second study (34) demonstrated that a BNP level of less than 50 pg/mmol excluded an adverse outcome from acute pulmonary embolism with 95% accuracy.…”

Section: Bnp Versus Nt-probnpmentioning

confidence: 99%

“…In addition, elevation of BNP has prognostic importance in pulmonary embolism; in one study (33), a BNP level of less than 21.7 pg/mmol excluded fatal pulmonary embolism with 99% accuracy, while a second study (34) demonstrated that a BNP level of less than 50 pg/mmol excluded an adverse outcome from acute pulmonary embolism with 95% accuracy. Similar findings were made with NT-proBNP levels in patients with acute pulmonary embolism (35).…”

Section: Bnp Versus Nt-probnpmentioning

confidence: 99%

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Combining tissue Doppler echocardiography and B-type natriuretic peptide in the evaluation of left ventricular filling pressures: Review of the literature and clinical recommendations

Dokainish¹

2007

Canadian Journal of Cardiology

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Dyspnea is a common presenting symptom in patients seeking medical attention. However, determining the exact cause of dyspnea in a given patient can prove to be difficult, especially in patients with a noncardiac cause of dyspnea in the setting of known cardiac disease. Although invasively measured left ventricular (LV) filling pressure is the reference standard for establishing that pulmonary venous pressure elevation is contributing to symptoms of dyspnea in a given patient, it is not clinically feasible to subject all patients presenting with dyspnea to cardiac catheterization. Therefore, noninvasive methods of estimating LV filling pressures -B-type natriuretic peptide (BNP) measurement and the tissue Doppler (TD)-derived transmitral early diastolic/annular velocity ratio (E/Ea) -have attracted attention. Both BNP and mitral E/Ea possess important strengths and limitations. Therefore, in certain clinical scenarios, combining these indexes is superior to using either in isolation. However, there has been, to date, no clear consensus on the optimal clinical use of BNP and E/Ea in patients presenting with dyspnea. Therefore, the present paper comprehensively reviews the current literature on BNP and E/Ea, and makes clinical recommendations on the optimal use of these variables in patients with dyspnea and suspected congestive heart failure (CHF). A BRIEF HISTORY OF TD IMAGINGTD imaging of the heart is a Doppler technique that measures the frequency of ultrasound returning from moving myocardium to estimate the velocity of the myocardial wall. In 1989, Isaaz et al (1) were the first to describe clinical applications of TD in cardiac disease, demonstrating that low myocardial velocities at the posterior mitral annulus correlated with abnormal posterior wall motion on LV angiography. Gulati et al (2) demonstrated in 1996 that TD systolic mitral annular velocities correlated with global LV ejection fraction (EF), as assessed by radionuclide ventriculography. It was then shown that TD-derived Ea correlated with the invasively measured LV time constant of relation (Tau), establishing Ea as a relatively load-independent measure of myocardial Consequently, mitral E/Ea can help to establish the presence of clinical congestive heart failure in patients with dyspnea. However, E/Ea has a significant 'gray zone', and is not well validated in nonsinus rhythm and mitral valve disease. B-type natriuretic peptide (BNP) is a protein released by the ventricles in the presence of myocytic stretch, and has been correlated to LV filling pressure and, independently, to other cardiac morphological abnormalities. In addition, BNP is significantly affected by age, sex, renal function and obesity. Given its correlation with multiple cardiac variables, BNP has high sensitivity, but low specificity, for the detection of elevated LV filling pressures. Taking into account the respective strengths and limitations of BNP and mitral E/Ea, algorithms combining them can be used to more accurately estimate LV filling pressures in patients presenti...

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Section: Bnp Versus Nt-probnpmentioning

confidence: 99%

Section: Bnp Versus Nt-probnpmentioning

confidence: 99%

Combining tissue Doppler echocardiography and B-type natriuretic peptide in the evaluation of left ventricular filling pressures: Review of the literature and clinical recommendations

Dokainish¹

2007

Canadian Journal of Cardiology

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“…BNP is elevated in PH of various classes: idiopathic (IPAH) [10]; PAH associated with connective tissue disease [11], congenital systemic-to-pulmonary shunts [12] and treatment of Gaucher's disease [13]; and PH associated with chronic obstructive pulmonary disease [14], interstitial lung disease [15], chronic thromboembolic disease [16,17] and acute pulmonary embolus [18,19]. BNP levels correlate with haemodynamic parameters [10,[15][16][17][20][21][22][23], exercise capacity and NYHA functional class [21].…”

Section: Natriuretic Peptidesmentioning

confidence: 99%

“…BNP levels correlate with haemodynamic parameters [10,[15][16][17][20][21][22][23], exercise capacity and NYHA functional class [21]. BNP is of prognostic significance in IPAH [10], in chronic lung disease [24] and in pulmonary embolism [18,19]. In one study, baseline BNP was measured in 60 patients with IPAH, and repeated after a mean of 3 months; patients were followed for a mean of 24 months [10].…”

Section: Natriuretic Peptidesmentioning

confidence: 99%

Biomarkers in pulmonary hypertension

Warwick

Thomas²,

Yates³

2008

European Respiratory Journal

136

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There have been significant recent advances in the understanding of the pathophysiology of pulmonary hypertension, and a growing number of therapeutic agents have become available to the treating physician. Traditional methods of diagnosing and monitoring this condition have comprised echocardiography and right heart catheterisation, in addition to functional measures, such as estimation of functional class and the 6-min walk test. An increasing number of biomarkers have been described that are elevated in pulmonary hypertension and which may assist the clinician in diagnosis and in the assessment of disease severity and response to treatment.The present article details the more important biomarkers, their potential applications and the evidence supporting their use.

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“…[3][4][5] This neurohormone, which has a serum half-life of Ϸ20 minutes, has been shown to directly correlate with pulmonary capillary wedge pressure. 6,7 BNP is also considered a good predictor of major cardiovascular events and sudden death in patients with unstable angina, myocardial infarction, and ischemic cardiomyopathy.…”

mentioning

confidence: 99%

Elevated Brain Natriuretic Peptide Predicts Blood Pressure Response After Stent Revascularization in Patients With Renal Artery Stenosis

et al. 2005

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Background-A significant number (20% to 40%) of hypertensive patients with renal artery stenosis will not have blood pressure improvement after successful percutaneous revascularization. Identifying a group of patients with refractory hypertension and renal artery stenosis who are likely to respond to renal stent placement would be beneficial. Methods and Results-Brain natriuretic peptide (BNP) was measured in 27 patients with refractory hypertension and significant renal artery stenosis before and after successful renal artery stent placement. This neuropeptide was elevated (median, 187 pg/mL; 25th to 75th percentiles, 89 to 306 pg/mL) before stent placement and fell within 24 hours of the successful stent procedure (96 pg/mL; 25th to 75th percentiles, 61 to 182 pg/mL; Pϭ0.002), remaining low (85 pg/mL; 25th to 75th percentiles, 43 to 171 pg/mL) at follow-up. Clinical improvement in hypertension was observed in the patients with a baseline BNP Ͼ80 pg/mL (nϭ22) in 17 patients (77%) compared with 0% of the patients with a baseline BNP Յ80 pg/mL (nϭ5) (Pϭ0.001). After correction for glomerular filtration rate, BNP was strongly correlated with improvement in hypertension. Conclusions-BNP is increased in patients with severe renal artery stenosis and decreases after successful stent revascularization. In addition, an elevated baseline BNP level of Ͼ80 pg/mL appears to be a good predictor of a blood pressure response after successful stent revascularization. (Circulation. 2005;111:328-333.)

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Brain Natriuretic Peptide as a Predictor of Adverse Outcome in Patients With Pulmonary Embolism

Abstract: This is the first study to show that plasma BNP levels seem to predict adverse outcome in patients with acute pulmonary embolism.

Cited by 242 publications

References 14 publications

Combining tissue Doppler echocardiography and B-type natriuretic peptide in the evaluation of left ventricular filling pressures: Review of the literature and clinical recommendations

Combining tissue Doppler echocardiography and B-type natriuretic peptide in the evaluation of left ventricular filling pressures: Review of the literature and clinical recommendations

Biomarkers in pulmonary hypertension

Elevated Brain Natriuretic Peptide Predicts Blood Pressure Response After Stent Revascularization in Patients With Renal Artery Stenosis

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