Predictive Power of N-terminal Prohormone of Brain Natriuretic Peptide on Admission and on Discharge for Short- and Long-term Clinical and Echocardiographic Outcomes in Patients With Pulmonary Thromboembolism

Document Type: Original Article

Authors

1 Atherosclerosis Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran.

2 Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, IR Iran..

3 Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, IR Iran.

4 Research Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, IR Iran.

Abstract

Background: This prospective case-series study was conducted to determine the predictive power of the N-terminal prohormone of brain natriuretic peptide (NT-proBNP) on shortand long-term outcomes in patients with pulmonary thromboembolism (PTE).
Methods: Ninety-two patients (age = 60 ± 1.97 y, 54.7% male) diagnosed with PTE were recruited. NT-proBNP levels and echocardiographic indices were measured and recorded. The primary endpoint was considered to be 3-month PTE-related deaths and long-term adverse outcomes including 1-year all-cause mortality, rehospitalization due to the recurrence of PTE, right ventricular dysfunction, and pulmonary hypertension.
Results: The serum NT-proBNP level and the right ventricular diameter were significantly higher in the patients with adverse outcomes than in the outcome-free patients. Several significant correlations were found between NT-proBNP levels and echocardiographic indices. During a mean follow-up time of 12 months, 1 patient suffered PTE relapse, 15 patients had right ventricular dysfunction and pulmonary hypertension, and 2 patients expired. Age was an independent value in the prediction of the adverse outcome (OR: 1.064, 95% CI: 1.01 to 1.11). Discharge NT-proBNP levels, calculated according to a multiple cutoff point strategy for heart failure, in the PTE patients with adverse outcomes was 2.36 fold that in the outcome-free patients. The optimal value for discharge NTproBNP according to the receiver operating characteristic analysis was 327 pg/mL, with a sensitivity of 80% and a specificity of 43%.
Conclusions: NT-proBNP measurement during the course of PTE, especially on discharge, may have a role as an easy-to-use diagnostic tool for determining patients with poor prognoses.

Keywords


1. Klok FA, Zondag W, van Kralingen KW, et
al. Patient outcomes after acute pulmonary
embolism: a pooled survival analysis of
different adverse events. American journal
of respiratory and critical care medicine
2010;181(5):501-06.
2. Members ATF, Torbicki A, Perrier A, et al.
Guidelines on the diagnosis and
management of acute pulmonary embolism:
the Task Force for the Diagnosis and
Management of Acute Pulmonary Embolism
of the European Society of Cardiology
(ESC). European heart journal
2008;29(18):2276-315.
3. Tapson VF. Advances in the diagnosis and
treatment of acute pulmonary embolism.
F1000 medicine reports 2012;4
4. Kreit JW. The impact of right ventricular
dysfunction on the prognosis and therapy of
normotensive patients with pulmonary
embolism. Chest 2004;125(4):1539-45.
5. Schoepf UJ, Kucher N, Kipfmueller F, et al.
Right ventricular enlargement on chest
computed tomography: a predictor of early
death in acute pulmonary embolism.
Circulation 2004;110(20):3276-80.

6. Dellas C, Lankeit M, Reiner C, et al. BMIindependent inverse relationship of plasma
leptin levels with outcome in patients with
acute pulmonary embolism. International
Journal of Obesity 2013;37(2):204.
7. Becattini C, Vedovati MC, Agnelli G.
Prognostic value of troponins in acute
pulmonary embolism: a meta-analysis.
Circulation 2007;116(4):427-33.
8. Lankeit M, Dellas C. Panzenbö ck A, SkoroSajer N, Bonderman D, OIschewski M, et al.
Heart-type fatty acid-binding protein for risk
assessment of chronic thromboembolic
pulmonary hypertension. Eur Respir J
2008;31:1024-9.
9. Zondag W, Agterof MJ, Schutgens RE, et al.
Repeated NT-proBNP testing and risk for
adverse outcome after acute pulmonary
embolism. Thrombosis and haemostasis
2011;105(06):1226-27.
10. Pruszczyk P, Kostrubiec M, Bochowicz A,
et al. Nterminal pro-brain natriuretic
peptide in patients with acute pulmonary
embolism. European Respiratory Journal
2003;22(4):649-53.
11. Vavera Z, Vojáček J, Pudil R, et al. NTproBNP levels on admission predicts
pulmonary hypertension persistence in
patients with acute pulmonary embolism.
Cor et Vasa 2012;54(1):e27-e31.
12. Dores H, Fonseca C, Leal S, et al. NTproBNP for risk stratification of pulmonary
embolism. Revista Portuguesa de
Cardiologia (English Edition)
2011;30(12):881-86.
13. Kostrubiec M, Pruszczyk P, Kaczynska A, et
al. Persistent NT-proBNP elevation in acute
pulmonary embolism predicts early death.
Clinica chimica acta 2007;382(1-2):124-28.
14. Alonso-Martínez JL, Annicchérico-Sánchez
FJ, Urbieta-Echezarreta MA, et al. Nterminal Pro-B type natriuretic peptide as
long-term predictor of death after an acute
pulmonary embolism. Medicina Clínica
(English Edition) 2015;144(6):241-46.
15. Seyyedi Sr, Jenab Y, Tokaldany ML, et al.
Syncope paradox in the outcome of patients
with pulmonary thromboembolism:
shortterm and midterm outcome. The
clinical respiratory journal 2016;10(1):90-
97.
16. Jenab Y, Alemzadeh-Ansari MJ, Fehri SA,
et al. Effect of delay in hospital presentation
on clinical and imaging findings in acute
pulmonary thromboembolism. The Journal
of emergency medicine 2014;46(4):465-71.
17. Wicki J, Perrier A, Perneger TV, et al.
Predicting adverse outcome in patients with
acute pulmonary embolism: a risk score.
Thrombosis and haemostasis
2000;83(04):548-52.
18. Qanadli SD, El Hajjam M, Vieillard-Baron
A, et al. New CT index to quantify arterial
obstruction in pulmonary embolism:
comparison with angiographic index and
echocardiography. American Journal of
Roentgenology 2001;176(6):1415-20.
19. Venkatesh SK, Wang SC. Central clot score
at computed tomography as a predictor of
30-day mortality after acute pulmonary
embolism. Annals Academy of Medicine
Singapore 2010;39(6):442.
20. Chan CM, Woods C, Shorr AF. The
validation and reproducibility of the
pulmonary embolism severity index. Journal
of Thrombosis and Haemostasis
2010;8(7):1509-14.
21. Righini M, ROY PM, Meyer G, et al. The
Simplified Pulmonary Embolism Severity
Index (PESI): validation of a clinical
prognostic model for pulmonary embolism.
Journal of thrombosis and haemostasis
2011;9(10):2115-17.
22. Porapakkham P, Porapakkham P, Zimmet H,
et al. B-type natriuretic peptide–guided heart
failure therapy: a meta-analysis. Archives of
Internal Medicine 2010;170(6):507-14.
23. Morrison LK, Harrison A, Krishnaswamy P,
et al. Utility of a rapid B-natriuretic peptide
assay in differentiating congestive heart
failure from lung disease in patients
presenting with dyspnea. Journal of the American College of Cardiology
2002;39(2):202-09.
24. McCullough PA, Nowak RM, McCord J, et
al. B-type natriuretic peptide and clinical
judgment in emergency diagnosis of heart
failure: analysis from Breathing Not
Properly (BNP) Multinational Study.
Circulation 2002;106(4):416-22.
25. Berger R, Huelsman M, Strecker K, et al. Btype natriuretic peptide predicts sudden
death in patients with chronic heart failure.
Circulation 2002;105(20):2392-97.
26. Omland T, Persson A, Ng L, et al. Nterminal pro-B–type natriuretic peptide and
long-term mortality in acute coronary
syndromes. Circulation 2002;106(23):2913-
18.
27. Maisel AS, Koon J, Krishnaswamy P, et al.
Utility of B-natriuretic peptide as a rapid,
point-of-care test for screening patients
undergoing echocardiography to determine
left ventricular dysfunction. American heart
journal 2001;141(3):367-74.
28. Etesamifard N, Shirani S, Jenab Y, et al.
Role of clinical and pulmonary computed
tomography angiographic parameters in the
prediction of short-and long-term mortality
in patients with pulmonary embolism.
Internal and emergency medicine
2016;11(3):405-13.
29. Kucher N, Printzen G, Doernhoefer T, et al.
Low pro-brain natriuretic peptide levels
predict benign clinical outcome in acute
pulmonary embolism. Circulation
2003;107(12):1576-78.
30. Becattini C, Agnelli G, Germini F, et al.
Computed tomography to assess risk of
death in acute pulmonary embolism: a metaanalysis. European Respiratory Journal
2014:erj01478-2013.
31. Sanchez O, Trinquart L, Colombet I, et al.
Prognostic value of right ventricular
dysfunction in patients with
haemodynamically stable pulmonary
embolism: a systematic review. European
heart journal 2008;29(12):1569-77.
32. Jenab Y, Lotfi-Tokaldany M, AlemzadehAnsari M-J, et al. Correlates of syncope in
patients with acute pulmonary
thromboembolism. Clinical and Applied
Thrombosis/Hemostasis 2015;21(8):772-76.