Correlation of plasma B-type natriuretic peptide (BNP) levels with electrocardiographic (ECG) signs of right ventricular strain in patients with acute pulmonary embolism
Alina Mihaela Pascu1,2, Mariana Radoi1,2, Elena Bobescu1,2 & Mihail Coculescu3,4
Background: We previously demonstrated plasma BNP to be a valuable biomarker of right ventricular dysfunction (RVD) in patients with acute pulmonary embolism (PE). Several specific ECG abnormalities related to the right ventricular strain were described in patients with PE.
Objective: Assessment of the correlation of plasma BNP levels with ECG signs of RVD in patients with PE.
Methods: Seventy patients with confirmed acute PE, 42(60%) men, mean age 52.5±8.8, were prospectively investigated. BNP was measured on admission, using a quantitative immunofluorescence assay (Triage BNP, Biosite Inc). Twelve-lead ECG was registered in all 70 patients in the first hour after admission. ECGs were independently interpreted by two observers blinded to patient data. RV function was assessed by echocardiography (ECHO), performed by an investigator blinded to other results. Study protocol was approved by local Ethical Committee. Statistics: SPSS 17.0.2; MedCalc 11.1.1.
Results: Plasma BNP levels were significantly higher in patients with RVD on ECHO: 79.75(45.77, 329.75) pg/mL compared to patients with normal RV function: 7.85(6.22, 16.07) pg/ml, P<0.0001, values expressed as medians (25th, 75th percentiles). There was a significant correlation between plasma BNP and a heart rate >100 bpm: r=0.602 (95% confidence interval CI=0.4270.733), P<0.0001. Qr in V1 lead (a prominent Q wave of ≧0.2 mV and a ventricular depolarisation <120 ms) was also significantly correlated with plasma BNP: R=0.635 (95% CI=0.4710.757), P<0.0001. Plasma BNP was significantly associated with the presence of incomplete right bundle branch block (RBBB), R=0.440 (95% CI=0.2290.612), P<0.0001; S1 subtypes (S1Q3/S1rSr3/S1S2S3), R=0.339(95% CI=0.1130.532), P=0.004; inversed T wave in anterior leads (V2 or V3), R=0.632 (95% CI=0.4670.755), P<0.001.
Conclusions: Plasma BNP was significantly correlated with ECG signs of RVD in patients with acute PE. Multivariate logistic regression analysis showed that heart rate >100 bpm and the presence of a Qr ventricular complex in V1 lead proved to be the best ECG indicators of right ventricular strain in patients with PE.