Prognostic value of brain natriuretic peptide and troponin I in moderate and high risk pulmonary embolism

Guillermo Jaimovich, Juan Benger, Walter M. Masson, Mauro L. Giacomini, Pablo F. Oberti, José L. Navarro Estrada, Arturo M. Cagide

Abstract


Background

Brain natriuretic peptide (BNP) and troponins are useful markers for risk stratification in pulmonary thromboembolism (PTE). However, it is not clear which of the two biomarkers has better association with the clinical severity of this condition.

Objective

The aim of this study was to assess both biomarkers in moderate and high risk populations.

Methods

A prospective study was undertaken to analyze all patients diagnosed with PTE who had positive troponin I (TI) or BNP levels. An echocardiogram within the first 24 hours and clinical follow up during hospitalization were performed on these patients. A composite endpoint of death, recurrent PTE, shock, hypotension, mechanical ventilation and thrombolytic therapy was established. The association of both serum markers with the described events was assessed.

Results

Seventy one consecutive patients were included in this study. Patients with moderate or severe right ventricular dysfunction had higher BNP levels (661 pg/ml (420-1113) vs. 316 pg/ml (129-570) p=0.002) without significant difference in TI levels (0.115 ng/ml (0.015-0.345) vs. 0.24 ng/ml (0.076-0.58) p=0.0788). BNP levels were higher in patients with composite endpoint [604 pg/ml (370-934) vs. 316 pg/ml (148-900) p=0.042], whereas no similar association was found for TI [0.12 ng/ml (0.037-0.48) vs. 0.13 ng/ml (0.07-0.41) p=0.46].

Conclusions

BNP showed higher values in patients with right ventricular dysfunction and composite endpoint, indicating its greater sensitivity to identify patients with more severe clinical involvement.


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