N-terminal Pro-brain Natriuretic Peptide, High-sensitivity Troponin and Pulmonary Artery Clot Score as Predictors of Right Ventricular Dysfunction in Echocardiography

• Published in: Heart, lung & circulation lung & circulation, 2016-06, Vol.25 (6), p.592-599
• Main Authors: Granér, Marit, MD, PhD, Harjola, Veli-Pekka, MD, PhD, Selander, Tuomas, MSc, Laiho, Mia K., MD, PhD, Piilonen, Anneli, MD, Raade, Merja, MD, Mustonen, Pirjo, MD, PhD
• Format: Article
• Language: English
• Subjects: Adult; Aged; Biomarkers - blood; Cardiac biomarkers; Cardiovascular; Echocardiography; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain - blood; Peptide Fragments - blood; Pulmonary Artery - diagnostic imaging; Pulmonary artery clot score; Pulmonary embolism; Pulmonary Embolism - blood; Pulmonary Embolism - diagnostic imaging; Right ventricular dysfunction; Thrombosis - blood; Thrombosis - diagnostic imaging; Troponin - blood; Ventricular Dysfunction, Right - blood; Ventricular Dysfunction, Right - diagnostic imaging
• ISSN: 1443-9506; 1444-2892
• DOI: 10.1016/j.hlc.2015.12.004

Background We investigated the ability of cardiac biomarkers and total pulmonary artery (PA) clot score to predict right ventricular dysfunction (RVD) on admission and at seven-month follow-up in subjects with acute pulmonary embolism (APE). Methods Sixty-three normotensive patients with APE were divided into two groups: patients with (n= 32, age 58 ± 19 years) and without (n=31, age 55 ± 16 years) echocardiographic RVD. Transthoracic echocardiography (TTE), N-terminal pro-brain natriuretic peptide (NT-proBNP), and high-sensitivity troponin T (hsTnT) were assessed upon arrival and repeated at seven months. Total PA clot score was determined on admission. Results The age- and sex dependent NT-proBNP on admission, on day 5, and at seven months exhibited the best sensitivity (admission 94%, day 5 100%, seven months 100%) and negative predictive value (NPV) (89%, 100%, 100%) for detecting RVD. Six patients (10%) had persistent RVD at seven months. Total PA clot score showed only low to moderate sensitivity (77%) and PPV (7%) for detection of RVD at seven months. Conclusions Normal age- and sex dependent NT-proBNP on admission or measured five days later seems to be useful in exclusion of RVD at follow up. Total PA clot score shows only to be of modest benefit for predicting persistent RVD.