Usefulness of cardiac biomarkers in the prediction of right ventricular dysfunction before echocardiography in acute pulmonary embolism

Hong Sang Choi, Kye Hun Kim, Hyun Ju Yoon, Young Joon Hong, Ju Han Kim, Youngkeun Ahn, Myung Ho Jeong, Jeong Gwan Cho, Jong Chun Park, Jung Chaee Kang
Journal of Cardiology 2012, 60 (6): 508-13

BACKGROUND: The aim of this study was to investigate a useful cardiac biomarker for predicting echocardiographic right ventricular (RV) dysfunction in patients with acute pulmonary embolism (APE).

METHODS: A total of 84 patients with APE were divided into two groups: patients with RV dysfunction (group I, n=51, 61.8 ± 15.1 years) versus without RV dysfunction (group II, n=33, 66.8 ± 13.6 years). Cardiac biomarkers were compared between the groups.

RESULTS: The level of N-terminal pro-brain-type natriuretic peptide (NT-proBNP), cardiac specific troponin T (cTnt), and I (cTni) was significantly elevated in group I compared to group II, but the level of creatine kinase and high-sensitivity C-reactive protein was not different. By receiver operating characteristic curve analysis, the area under the curve to predict RV dysfunction was 0.912 for NT-proBNP, 0.797 for cTnt, and 0.766 for cTni. The optimal cut-off value to predict RV dysfunction was 620.0 pg/mL for NT-proBNP (sensitivity: 90.2%, specificity: 75.8%), 0.016 ng/mL for cTnt (sensitivity: 82.4%, specificity: 78.8%), and 0.055 ng/mL for cTni (sensitivity: 86.3%, specificity: 66.7%). NT-proBNP > 620 pg/mL and cTnt > 0.016 ng/mL were independent predictors of RV dysfunction on multivariate analysis after adjustment for the baseline characteristics.

CONCLUSIONS: NT-proBNP, cTnt, and cTni were significant serologic predictors of RV dysfunction in APE. Measurements of NT-proBNP, cTnt, and cTni are simple and useful in the risk stratification or treatment of APE.

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