Clinical investigationBrain natriuretic peptide predicts right heart failure in patients with acute pulmonary embolism
Section snippets
Patients
We prospectively studied all patients with confirmed acute PE who were admitted to the intensive care unit of our department between September 2000 and May 2002. Patients examined later than 3 days after the onset of symptoms were excluded. The diagnosis of PE was confirmed with computed spiral tomography, pulmonary angiography, or high-probability lung perfusion scintigraphy.18 In the absence of preexisting chronic pulmonary disease, a combination of abnormal echocardiography results and
Patients
Fifty consecutive patients with acute PE were studied. The baseline clinical variables of the study population are displayed in Table I.
Ten patients (20%) were diagnosed as having massive PE, 21 patients (42%) with moderate to large PE and 19 patients (38%) with small PE. The principal symptoms were dyspnea (86%), chest pain (56%), and syncope (16%). Risk factors included major surgery within 2 weeks of diagnosis (20% of patients), history of prior deep vein thrombosis or thromboembolism
Discussion
In this study, we demonstrated that in acute PE: 1) pathological BNP levels are frequently found in patients with RV dysfunction, but not in patients without RV dysfunction; 2) BNP is discriminative for the detection of RV dysfunction; 3) BNP determination is not helpful in patients with LV systolic dysfunction; and 4) pathological BNP levels are not predictive of in-hospital complications and the mortality rate of PE.
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2020, Critical Care ClinicsCitation Excerpt :BNP is released as a result of increased myocardial wall stress in the setting of RV dysfunction due to PE. As would be expected, increased levels of BNP or NT-proBNP in patients with acute PE have been shown to be associated with RV dysfunction.47 In a meta-analysis of 1132 patients with acute PE, elevated BNP and NT-pro BNP were associated with an increased risk of 30-day mortality (OR 6.5; 95% CI 2–21) and in-hospital adverse clinical outcomes, including death, cardiopulmonary resuscitation, mechanical ventilation, use of vasopressors, thrombolysis, thrombosuction, surgical embolectomy, or admission to the ICU (OR 8.7; 95% CI 2.8–27).48
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