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The Prognostic Role of B-type Natriuretic Peptide in Acute Pulmonary Thromboembolism  

Lee, Su Jin (Department of Internal Medicine, College of Medicine, Pusan National University)
Lee, Jae Hyung (Department of Internal Medicine, College of Medicine, Pusan National University)
Park, Ji Young (Department of Internal Medicine, College of Medicine, Pusan National University)
Jo, Woo Sung (Department of Internal Medicine, College of Medicine, Pusan National University)
Kim, Ji Eun (Department of Internal Medicine, College of Medicine, Pusan National University)
Kim, Ki Uk (Department of Internal Medicine, College of Medicine, Pusan National University)
Park, Hye Kyung (Department of Internal Medicine, College of Medicine, Pusan National University)
Kim, Yun Seong (Department of Internal Medicine, College of Medicine, Pusan National University)
Lee, Min Ki (Department of Internal Medicine, College of Medicine, Pusan National University)
Park, Soon Kew (Department of Internal Medicine, College of Medicine, Pusan National University)
Publication Information
Tuberculosis and Respiratory Diseases / v.60, no.5, 2006 , pp. 540-547 More about this Journal
Abstract
Background : Vital stability and right side heart failure are major prognostic factors of acute pulmonary thromboembolism. While it is important to recognize right side heart failure, it is often difficult in real practice. Recently, several studies have described early diagnostic tools for detecting right side heart failure including echocardiography and biochemical markers. This study, we evaluated the prognostic role of the B-type natriuretic peptide (BNP) in an acute pulmonary thromboembolism. Methods : Thirty-four patients with a diagnosis of acute pulmonary thromboembolism were enrolled in the study. The BNP levels were measured and echocardiography was performed at the Emergency Department. Data on the prognostic factors including ventilatory support, vital stability, pulmonary artery pressure, degree of tricuspid valve regurgitation, complications and death was collected from the patients' medical records. The patients with an acute pulmonary thromboembolism were divided into two groups based on the vital stability and the BNP level and the cutoff values and prognostic factors of the two groups were compared. Results : The predictors of the vital stability that influence the prognosis of patients with acute pulmonary thromboembolism were the BNP level, ventilatory support and death. The plasma BNP levels showed a strong correlation with the vital stability, ventilatory support, thrombolytic therapy and death. When the BNP cutoff level was set to 377.5 pg/dl in a ROC curve, the sensitivity and the specificity for differentiating between the groups with stable or unstable vital signs was 100% and 90%, respectively. Conclusion : This study indicates that a measurement of the plasma BNP levels may be a useful prognostic marker in patients with an acute pulmonary thrombo-embolism.
Keywords
BNP; Echocardiography; Acute pulmonary thromboembolism;
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1 Horlander KT, Mannino DM, Leeper KV. Pulmonary embolism mortality in the United States, 1979-1998: an analysis using mulitple-cause mortality data. Arch Intern Med 2003;163:1711-7   DOI
2 Jardin F, Dubourg O, Bourdarias JP. Echocardio-graphic pattern of acute cor pulmonale Chest 1997;111:209-17   DOI
3 De Lemos JA, McGurie DK, Drazner MH. B-type natriuretic peptide in cardiovascular disease. Lancet 2003;362:316-22   DOI   ScienceOn
4 Henry WL, DeMaria A, Gramiak R, King DL, Kisslo JA, Popp RL, et al. Report of the American Society of Echocardiography Committee on Nomenclature and Standards in Two-dimensional Echocardiography. Circulation 1980;62:212-7   DOI   ScienceOn
5 Sudoh T, Kangawa K, Minamino N, Matsuo H. A new natriuretic peptide in porcine brain. Nature 1998;332:78-81   DOI   ScienceOn
6 Marcus LS, Hart D, Packer M, Yushak M, Medina N, Daziger RS, et al. Hemodynamic and renal excretory effects of human brain natriuretic peptide infusion in patients with congestive heart failure. A double-blind, placebo-controled, randomized crossover trial. Circulation 1996;94:3184-9   DOI   ScienceOn
7 Tulevski II, Groenink M, Van der Wall E, van Veldhuisen DJ, Boomsma F, Stoker J, et al. Increased Brain and Atrial Natriuretic peptides in Patients with Chronic Right Ventricular Pressure Overload:Correlation between Plasma Neurohormones and Right Ventricular Dysfunction. Heart 2001;86:27-30   DOI   ScienceOn
8 Kucher N, Printzen G, Goldhaber SZ. Prognostic role of brain natriuretic peptide in acute pulmonary embolism. Circulation 2003;107:2545-7   DOI   ScienceOn
9 Gerald Chua, Kang-Hoe Lee. Marked elevations in N-terminal brain natriuretic peptide levels in septic shock. Critical Care 2004;8:R248-50   DOI
10 Dalen JE, Alpert JS. Natural history of pulmonary embolism. Prog Cardiovasc Dis 1975;17:259-70   DOI   ScienceOn
11 Hosoda K, Nakao K, Mukoyama M, Saito Y, Jouqasaki H, Shirakami G, et al. Expression of brain natriuretic peptide gene in human heart, Production in the ventricle. Hypertension 1991;17:1152-5   DOI
12 Morice AH, Pepke-Zaba J, Brown MJ, Thamas PS, Higenbottam TW. Atrial natriuretic peptide in primary pulmonary hypertension. Eur Respir J 1990;3:910-3
13 Kasper W, Kostantinides S, Geibel A, Tiede N, Krause T, Just H. Prognostic significance of right ventricular afterload stress detected by echocardiography in patients with clinically suspected pulmonary embolism. Heart 1997;77:346-9   DOI
14 Scientific Committee for National Survey of Acute Pulmonary Thromboembolism. The National Survey of Acute Pulmonary Thromboembolism in Korea. Tuberculosis and Respiratory Disease 2003;54:5-14   DOI
15 Sawada Y, Suda M, Yokoyama H, Kanda T, Sakamaki T, Tanaka S, et al. Stretch-induced hypertrophic growth of cardiocytes and processing of brain type natriuretic peptide are controlled by proprotein-processing ednoprotease furin. J Biol Chem 1997;272:20545-54   DOI   ScienceOn
16 Troughton RW, Frampton CM, Yandle TG, Espiner EA, Nicholls MG, Richards AM. Treatment of heart failure guided by plasma aminoterminal brain natriuretic peptide(N-BNP) concentrations. Lancet 2000;355:1126-30   DOI   ScienceOn
17 Kruger S, Graf J, Merx MW, Koch KC, Kunz D, Hanrath P, et al. Brain natriuretic peptide predicts right heart failure in patients with acute pulmonary embolism. Am Heart J 2004;147:60-5   DOI   ScienceOn
18 Carson JL, Kelley MA, Duff A, Weg JG, Fuekerson WJ, Palevsky HI, et al. The clinical course of pulmonary embolism. N Engl J Med 1992;326:1240-5   DOI   ScienceOn
19 Ishii J, Ito M, Naruse H, Mori Y, Wang JH, Ishikawa T, et al. Plasma concentration of brain natriuretic peptide as a biochemical marker for the evaluation of right ventricular overload and mortality in chronic respiratory disease. Clin Chim Acta 2000;301:19-30   DOI
20 Ribeiro A, Juhlin-Dannfelt A, Brodin LA, Holmgren A, Jorfeldt L. Pulmonary embolism: relation between the degree of right ventricle overload and the extent of perfusion defects. Am Heart J 1998;135:868-74   DOI
21 Bilkovski RN, Kulstad EB. Elevations of B-type natriuretic peptide in pulmonary embolism: a case series. J Emerg Med 2003;25:415-20   DOI   ScienceOn
22 Tung RH, Garcia C, Morss AM, Pino RM, Fifer MA, Thompson BT, et al. Utility of B-type natriuretic peptide for the evaluation of intensive care unit shock. Crit Care Med 2004;32:1643-7   DOI   ScienceOn
23 Dismuke SE, Wagner EH. Pulmonary embolism as a cause of death. The changing mortality in hospitalized patients. JAMA 1986;255:2039-42   DOI   ScienceOn
24 Grifoni S, Olivotto I, Cecchini P, Pieralli F, Camaiti A, Santoro G, et al. Short-term clinical outcome of patients with acute pulmonary embolism, normal blood pressure, and echocardiographic right ventricular dysfunction. Circulation 2000;101:2817-22   DOI   ScienceOn
25 Magga J, Puhakka M, Hietakorpi S, Uusimaa P, Punnonen K, Risteli J, et al. Atrial natriuretic peptide, B-type natriuretic peptide, and serum collagen markers after acute myocardial infarction. J Appl Physiol 2004;96:1306-11   DOI   ScienceOn
26 McLean AS, Huang SJ, Nalos M, Tang B, Stewart DE. The confounding effects of age, gender, serum creatinine, and electrolyte concentrations on plasma B-type natriuretic peptide concentrations in critically ill patients. Crit Care Med 2003;31:2611-8   DOI   ScienceOn
27 Torbicki A, van Beek EJR, Charbonnier B, Meyer G, Morpurgo M, Palla A, et al. Guideline on diagnosis and management of acute pulmonary embolism. Eur Heart J 2000;21:1301-36   DOI   ScienceOn