Background: Acute right ventricular dysfunction (RVD) on echocardiography (ECHO) is critical for risk stratification in pulmonary embolism (PE). Plasma BNP, a consecrated marker of left ventricular dysfunction, could represent a valuable biomarker of RVD in PE.
Aim and objective: Assessment of plasma BNP levels in patients with PE in relationship with right ventricular (RV) function evaluated by ECHO.
Methods: Prospective study of 70 patients with confirmed PE, 42 men (60%), mean age 52.5±8.8. Plasma BNP levels were measured on admission using a quantitative fluorescence immunoassay (Triage BNP). ECHO evaluation of the RV function was performed in the first hour after admission. Study protocol was approved by local Ethical Committee. Patients were divided in two groups: group 1 with acute RVD on ECHO, n=24 patients (34.3%); group 2 without acute RVD on ECHO, n=46 patients (65.7%).
Statistics: SPSS 14.0; MedCalc 8.1.
Results: Plasma BNP levels were significantly higher in patients with acute RVD on ECHO (group 1), median value (25th, 75th percentiles)=79.75 (45.77, 329.75) pg/mL vs. 7.85 (6.22, 16.07) pg/mL in patients without acute RVD on ECHO (group 2), P<0.0001. BNP proved good in discriminating between patients with and without acute RVD area under the receiver operating characteristic curve=0.86 (95% Confidence Interval C.I. 0.770.94), P<0.0001. The cut-off level of plasma BNP=50 pg/mL had the best sensitivity=0.84 (95% C.I. 0.790.88) and specificity=0.80 (95% C.I. 0.750.85) in the same time in identifying acute RVD. Plasma BNP correlated significantly with RV end-diastolic diameter (R=0.74, P<0.0001), RV systolic pressure (R=0.77, P<0.0001). Logistic regression analysis showed that plasma BN P>50 pg/mL was the best acute RVD predictor, odds ratio 21.0 (95% C.I. 5.579.5).
Conclusions: Plasma BNP higher than a cut-off level of 50 pg/mL could predict acute right ventricular dysfunction in patients with pulmonary embolism with a good sensitivity and specificity.