Can brain natriuretic peptide predict the outcome in patients with acute pulmonary embolism?

Abstract

Risk of death is high in patients with pulmonary embolism (PE) because of right ventricular (RV) failure. Plasma levels of brain natriuretic peptide (BNP) are increased in cases of isolated chronic right ventricular dysfunction (RVD) and chronic pulmonary hypertension. However, little is known about BNP secretion during acute RVD caused by acute PE. The aim of this study is to determine BNP levels in patients with acute PE with and without RVD and to assess its role in prediction of severity and outcome of these patients. Patients and methods: This study was conducted on 47 patients with confirmed acute PE who were admitted to the intensive care unit (ICU) of Chest Department, Zagazig University Hospitals. Patients enrolled in this study were subjected to: (a) Transthoracic echocardiography, (b) Measurement of BNP plasma levels, (c) Measurement of D-dimer serum levels and d) Computed tomography pulmonary angiography (CTPA). Results: There was statistically highly significant increase in plasma level of BNP (pg/mL) in patients with RVD than those without it. There were highly significant positive correlations between plasma level of BNP (pg/mL) and both RV diameter (mm) and RVSP (mmHg). A plasma BNP level >72.5 pg/mL can predict occurrence of RVD, while a plasma level of BNP >150 pg/mL can predict death in patients with acute PE. Conclusion: An elevated plasma level of BNP is a prognostic factor for short-term mortality and overall short-term complicated clinical outcome, and it is a powerful indicator of RVD in patients with acute PE in the absence of left ventricular dysfunction (LVD).

Keywords

• Acute pulmonary embolism
• Brain natriuretic peptide
• Right ventricular dysfunction