NT-pro-BNP levels in patients with acute pulmonary embolism are correlated to right but not left ventricular volume and function.
Thromb Haemost. 2012 Jun 28;108(2)
Authors: Pasha SM, Klok FA, van der Bijl N, de Roos A, Kroft LJ, Huisman MV
N-terminal pro-Brain Natriuretic Peptide (NT-pro-BNP) is primarily secreted by left ventricular (LV) stretch and wall tension. Notably, NT-pro-BNP is a prognostic marker in acute pulmonary embolism (PE), which primarily stresses the right ventricle (RV). We sought to evaluate the relative contribution of the RV to NT-pro-BNP levels during PE. A post-hoc analysis of an observational prospective outcome study in 113 consecutive patients with computed tomography (CT)-proven PE and 226 patients in whom PE was clinically suspected but ruled out by CT. In all patients RV and LV function was established by assessing ECG-triggered-CT measured ventricular end-diastolic-volumes and ejection fraction (EF). NT-pro-BNP was assessed in all patients. The correlation between RV and LV end-diastolic-volumes and systolic function was evaluated by multiple linear regression corrected for known confounders. In the PE cohort increased RVEF (ÃÂ²-coefficient (95% confidence interval [CI]) -0.044 (ÃÂ± -0.011); p<0.001) and higher RV end-diastolic-volume (ÃÂ²-coefficient 0.005 (ÃÂ± 0.001); p<0.001) were significantly correlated to NT-pro-BNP, while no correlation was found with LVEF (ÃÂ²-coefficient 0.005 (ÃÂ± 0.010); p=0.587) and LV end-diastolic-volume (ÃÂ²-coefficient -0.003 (ÃÂ± 0.002); p=0.074). In control patients without PE we found a strong correlation between NT-pro-BNP levels and LVEF (ÃÂ²-coefficient -0.027 (ÃÂ± -0.006); p<0.001) although not LV end-diastolic-volume (ÃÂ²-coefficient 0.001 (ÃÂ± 0.001); p=0.418). RVEF (ÃÂ²-coefficient -0.002 (ÃÂ± -0.006); p=0.802) and RV end-diastolic-volume (ÃÂ²-coefficient <0.001 (ÃÂ± 0.001); p=0.730) were not correlated in patients without PE. In PE patients, lower RVEF and higher RV end-diastolic-volume were significantly correlated to NT-pro-BNP levels as compared to control patients without PE. These observations provide pathophysiological ground for the well-known prognostic value of NT-pro-BNP in acute PE.
PMID: 22740123 [PubMed - as supplied by publisher]Link to Article at PubMed