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Choice of marker for assessment of RV dysfunction in acute pulmonary embolism

NT-proBNP, pulmonary artery systolic pressure, mean arterial pressure, or blood pressure index

Wahl eines Parameters zur Beurteilung einer RV-Dysfunktion bei akuter Lungenembolie

NT-proBNP, pulmonalarterieller systolischer Druck, mittlerer arterieller Druck oder Blutdruckindex

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Abstract

Background

We aimed to examine the value of NT-proBNP, pulmonary artery systolic pressure (PASP), blood pressure index (BPI), and mean arterial pressure (MAP) in the determination of right ventricular dysfunction (RVD) in patients with acute pulmonary embolism (APE).

Patients and methods

A total of 547 patients diagnosed with APE were included in the study. Demographic characteristics and comorbid conditions of patients were recorded in patient files. For blood pressure measurement, a calibrated digital blood pressure monitor was used at regular intervals. Blood samples were taken from patients at the time of admission for hemogram, biochemical, and hemostasis blood tests. Echocardiography was performed on all patients to detect RVD and evaluate pulmonary artery pressure.

Results

PASP (p < 0.001), MAP (p < 0.001), diastolic blood pressure (p < 0.001), D‑dimer (p = 0.001), NT-proBNP (p = 0.001), white blood cell (p < 0.001), and platelet (p = 0.001) counts were higher in APE patients with RVD compared with those without RVD, whereas the mean BPI level (p < 0.001) was lower. BPI had a negative correlation with PASP, NT-proBNP, platelet count, and triglyceride levels in patients with RVD. In regression analysis, BPI and PASP were found to be independent predictors of RVD. In receiver operating characteristic curve analysis, BPI (AUC ± SE = 0.975 ± 0.006; p < 0.001) was found to be the best predictor of RVD with a higher sensitivity (92.8%) and specificity (100%).

Conclusion

We found that BPI had a better diagnostic discrimination for RVD compared with PASP and NT-proBNP.

Zusammenfassung

Hintergrund

Ziel war es, die Überlegenheit von NT-proBNP, pulmonalarteriellem systolischem Druck (PASP), Blutdruckindex (BPI) oder mittlerem arteriellem Druck (MAP) zur Untersuchung einer rechtsventrikulären Dysfunktion (RVD) bei Patienten mit akuter Lungenembolie (APE) zu ermitteln.

Patienten und Methoden

Insgesamt wurden 547 Patienten mit APE in die Studie aufgenommen. Demographische Merkmale und Begleiterkrankungen der Patienten wurden in den Krankenakten dokumentiert. Zur Blutdruckmessung wurde in regelmäßigen Abständen ein kalibriertes digitales Blutdruckmessgerät verwendet. Bei Aufnahme ins Krankenhaus wurde den Patienten für ein Blutbild, biochemische und Gerinnungsparameter Blut entnommen. Eine Echokardiographie wurde bei allen Patienten durchgeführt, um ggf. eine RVD zu diagnostizieren und den pulmonalarteriellen Druck zu beurteilen.

Ergebnisse

PASP (p < 0,001), MAP (p < 0,001), diastolischer Blutdruck (p < 0,001), D‑Dimer (p = 0,001), NT-proBNP (p = 0,001), Leukozyten- (p < 0,001) und Thrombozytenzahl (p = 0,001) waren bei APE-Patienten mit RVD höher als bei Patienten ohne RVD, der mittlere BPI-Wert dagegen (p < 0,001) war niedriger. Der BPI wies eine negative Korrelation mit PASP, NT-proBNP, Thrombozytenzahl und Triglyzeridwerten bei Patienten mit RVD auf. In der Regressionsanalyse stellten sich BPI und PASP als unabhängige Prädiktoren einer RVD heraus. In der Receiver-Operating-Characteristic-Curve-Analyse erwies sich der BPI (Fläche unter der Kurve ± Standardfehler, AUC ± SE = 0,975 ± 0,006; p < 0,001) mit einer höheren Sensitivität (92,8%) und Spezifität (100%) als der beste Prädiktor einer RVD.

Schlussfolgerung

Die Autoren stellten fest, dass der BPI sich besser zur diagnostischen Abgrenzung einer RVD eignet als PASP und NT-proBNP.

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Authors and Affiliations

  1. Department of Chest Disease, Ankara Numune Training and Research Hospital, 06100, Ankara, Turkey

    H. Ates MD

  2. Department of Internal Medicine, Ankara Numune Training and Research Hospital, Ankara, Turkey

    I. Ates

  3. Department of Cardiology, Ankara Numune Training and Research Hospital, Ankara, Turkey

    H. Kundi

  4. Department of Biochemistry, Ankara Numune Training and Research Hospital, Ankara, Turkey

    F. M. Yilmaz

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Correspondence to H. Ates MD.

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Conflict of interest

H. Ates, I. Ates, H. Kundi, and F.M. Yilmaz declare that they have no competing interests.

The present study was designed in accordance with the Helsinki Declaration. It was approved by the local Ethics Board and Research Committee. Written consent was obtained from all participants included in the study.

Additional information

Author contribution. H. Ates, I. Ates, H. Kundi, and F.M. Yilmaz designed the research. I. Ates and F.M. Yilmaz analyzed the data. H. Ates and I. Ates wrote the paper. All authors take responsibility for the interpretation of data and critical revision of the manuscript for important intellectual content. H. Ates takes full responsibility for the integrity of the data and analyses.

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Ates, H., Ates, I., Kundi, H. et al. Choice of marker for assessment of RV dysfunction in acute pulmonary embolism. Herz 42, 758–765 (2017). https://doi.org/10.1007/s00059-016-4513-6

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  • DOI: https://doi.org/10.1007/s00059-016-4513-6

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