Endocrine Abstracts (2009) 20 P340

Limits in using brain natriuretic peptide (BNP) as a biomarker of acute right ventricular dysfunction in pulmonary embolism

Alina Mihaela Pascu1, Mariana Radoi2 & Mihail Coculescu3

1Department of Pathophysiology, Clinic of Cardiology, Faculty of Medicine, Transilvania University, Brasov, Romania; 2Department of Internal Medicine, Clinic of Cardiology, Faculty of Medicine, Transilvania University, Brasov, Romania; 3Department of Endocrinology, C.I. Parhon Institute of Endocrinology, Carol Davila University of Medicine and Pharmacy, Bucuresti, Romania.

Background: Risk stratification could be lifesaving in acute pulmonary embolism (PE). Echocardiographic (ECHO) acute right ventricular dysfunction (RVD) is the actual ‘gold standard’ in risk assessment of patients with PE. We previously demonstrated that plasma BNP levels were significantly higher in patients with PE and acute RVD on ECHO versus patients with normal right ventricular (RV) function on ECHO.

Aim and objective: Evaluation of the limits of plasma BNP in signalling acute RVD in patients with PE.

Methods: Seventy patients with confirmed PE were prospectively investigated: 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 16.0; MedCalc 9.6.

Results: Plasma BNP proved good in discriminating between patients with and without acute RVD – area under the receiver operating characteristic curve (AUC)=0.86 (95% Confidence Interval C.I. 0.77–0.94), P<0.0001. The cut-off level of plasma BNP=50 pg/ml showed the best sensitivity=0.84 (95% C.I. 0.79–0.88) and specificity=0.80 (95% C.I. 0.75–0.85) in the same time in identifying acute RVD. Eight patients from group 1, with acute RVD on ECHO, all admitted soon (<12 h) after the onset of their PE symptoms, and all experiencing at least one syncopal episode had BNP under the cut-off level.

Conclusions: Plasma BNP under the cut-off level of 50 pg/ml obtained by a unique assay could not exclude even a severe pulmonary embolism and should be interpreted with caution, especially in patients with significant and recent onset (<12 h) pulmonary embolism symptoms.

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