Journal
THROMBOSIS AND HAEMOSTASIS
Volume 108, Issue 2, Pages 367-372Publisher
SCHATTAUER GMBH-VERLAG MEDIZIN NATURWISSENSCHAFTEN
DOI: 10.1160/TH11-12-0901
Keywords
Venous thrombosis; heart; cardiac biomarker
Categories
Funding
- departments of Endocrinology and Radiology
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N-terminal pro-Brain Natriuretic Peptide (NT-pro-BNP) is primarily secreted by left ventricular (LV) stretch and wall tension. Notably, NT-pro-BNP is a prognostic marker in acute pulmonary embolism (PE), which primarily stresses the right ventricle (RV). We sought to evaluate the relative contribution of the RV to NT-pro-BNP levels during PE. A post-hoc analysis of an observational prospective outcome study in 113 consecutive patients with computed tomography (CT)-proven PE and 226 patients in whom PE was clinically suspected but ruled out by CT. In all patients RV and LV function was established by assessing ECG-triggered-CT measured ventricular end-diastolic-volumes and ejection fraction (EF). NT-pro-BNP was assessed in all patients. The correlation between RV and LV end-diastolic-volumes and systolic function was evaluated by multiple linear regression corrected for known con-founders. In the PE cohort increased RVEF (beta-coefficient (95% confidence interval (CI]) -0.044 (+/--0.011); p<0.001) and higher RV end-diastolic-volume (beta-coefficient 0.005 (+/- 0.001); p<0.001) were significantly correlated to NT-pro-BNP, while no correlation was found with LVEF (beta-coefficient 0.005 (+/- 0.010); p=0.587) and LV end-diastolic-volume (beta-coefficient -0.003 (+/- 0.002); p=0.074). In control patients without PE we found a strong correlation between NT-pro-BNP levels and LVEF (beta-coefficient -0.027 (+/--0.006); p<0.001) although not LV end-diastolic-volume (beta-coefficient 0.001 (+/- 0.001); p=0.418). RVEF (beta-coefficient -0.002 (+/- -0.006); p=0.802) and RV end-diastolic-volume (beta-coefficient <0.001 (+/- 0.001); p=0.730) were not correlated in patients without PE. In PE patients, lower RVEF and higher RV end-diastolic-volume were significantly correlated to NT-pro-BNP levels as compared to control patients without PE. These observations provide pathophysiological ground for the well-known prognostic value of NT-pro-BNP in acute PE.
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