Medizinische Universität Graz - Research portal
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SHR Neuro Cancer Cardio Lipid Metab Microb
Binder, L; Pieske, B; Olschewski, M; Geibel, A; Klostermann, B; Reiner, C; Konstantinides, S.
N-terminal pro-brain natriuretic peptide or troponin testing followed by echocardiography for risk stratification of acute pulmonary embolism.
Circulation. 2005; 112(11):1573-1579
Doi: 10.1161/CIRCULATIONAHA.105.552216
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- Co-authors Med Uni Graz
- Pieske Burkert Mathias
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- Abstract:
- Background - Brain natriuretic peptide (BNP) and N-terminal (NT)- proBNP have recently emerged as promising parameters for risk assessment in acute pulmonary embolism (PE). However, their positive predictive value is low, and the prognostic implications of NT- proBNP or troponin elevation alone are questionable. Methods and Results - To determine whether the combination of NT- proBNP testing with echocardiography may identify both low-risk and high-risk patients with PE, we examined 124 consecutive patients with proved PE. All underwent echocardiography on admission to detect right ventricular dysfunction. NT- proBNP and troponin concentrations were measured in one core laboratory. The primary end point was death or major in-hospital complications. The cutoff level of 1000 pg/mL had a high negative predictive value ( 95% for a complicated course, 100% for death), but NT- proBNP >= 1000 pg/ mL did not independently predict an adverse outcome. Combination of NT- proBNP testing with echocardiography identified 3 major risk groups. A positive echocardiogram was associated with a 12- fold elevation in complication risk compared with patients with low NT- proBNP ( P = 0.002), whereas NT- proBNP elevation without right ventricular dysfunction on echocardiography only slightly increased the risk of an adverse outcome ( P = 0.17). The combination of cardiac troponin testing with echocardiography yielded similar complication rates in the lowest- risk group and a similar magnitude of risk elevation for the highest- risk patients, but it also increased the number of intermediate- risk groups. Conclusions - Our results support a simple risk stratification algorithm for patients with PE, with the use of NT- proBNP or troponin testing as an initial step that should be followed by echocardiography if elevated levels of the biomarker are found.
- Find related publications in this database (using NLM MeSH Indexing)
- Acute Disease -
- Aged -
- Algorithms -
- Echocardiography -
- Female -
- Humans -
- Male -
- Middle Aged -
- Natriuretic Peptide, Brain - blood
- Osmolar Concentration -
- Peptide Fragments - blood
- Pulmonary Embolism - complications Pulmonary Embolism - mortality Pulmonary Embolism - physiopathology Pulmonary Embolism - ultrasonography
- Risk Assessment - methods Risk Assessment - standards
- Troponin - blood
- Find related publications in this database (Keywords)
- echocardiography
- embolism
- natriuretic peptides
- prognosis
- pulmonary heart disease