Endocrine Abstracts (2011) 26 P578

Utility of brain natriuretic peptide (BNP) as a biomarker of risk assessment in acute pulmonary embolism

Alina Mihaela Pascu1, Mariana Radoi1, Elena Bobescu1, Mihaela Stanciu2, Sebastian Ionut Toma1 & Olivia Ligia Burta3

1Transilvania University Brasov, Faculty of Medicine, Brasov, Romania; 2Lucian Blaga University Sibiu, Faculty of Medicine, Sibiu, Romania; 3Faculty of Medicine and Pharmacy Oradea, Oradea, Romania.

Introduction: Acute right ventricular dysfunction (RVD) on echocardiography (ECHO) represents the actual gold standard in risk stratification of patients with pulmonary embolism (PE). We previously demonstrated that plasma BNP above a cut-off level of 50 pg/ml could predict acute RVD in PE.

Aim and objective: Analysis of the utility and accuracy of plasma BNP in detecting acute RVD in PE.

Methods: Seventy patients with confirmed PE, 42 (60%) men, mean age 52.51±8.82 were prospectively investigated. Plasma BNP levels were measured on admission by a quantitative fluorescence immunoassay (Triage BNP). RV function was evaluated by ECHO in the first hour after admission. Patients were divided in two groups: group 1 – with acute RVD on ECHO, n=24 (34.29%) patients; group 2 – without acute RVD on ECHO, n=46 (65.71%) patients. Study protocol was approved by the local Ethics Committee.

Statistics: SPSS 16.0.; MedCalc 11.4.4.

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% CI (0.77–0.94, P<0.0001). Stepwise multiple regression analysis identified some patients’ characteristics independently and significantly associated with RVD: BNP≥50 pg/ml (R=0.61 (0.44–0.74), P<0.0001), syncope (R=0.57 (0.38–0.71), P<0.0001), a Qr type ventricular complex (a prominent Q wave of ≥0.2 mV and a ventricular depolarisation <120 ms) in V1 lead on electrocardiography (R=0.55 (0.36–0.69), P<0.0001), a heart rate>100 beats/min (R=0.54 (0.35–0.69), P<0.0001). Stepwise logistic regression (meta-analysis) proved BNP≥50 pg/ml to have the best accuracy in detecting RVD: odds ratio (OR) (95% CI)=21.00 (5.55–79.50), compared to: syncope (OR=9.33 (2.87–30.41)), Qr in V1 (OR=6.67 (2.06–21.55)), a heart rate>100 beats/min (OR=5.61 (1.86–16.99)).

Conclusion: Plasma BNP≥50 pg/dl was the best predictor of acute right ventricular dysfunction and a valuable biomarker of risk stratification in the patients with pulmonary embolism from our study group.

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