ABSTRACT

Background: Acute pulmonary embolism has a cardiovascular mortality rate of 15% to 20%. Patients with PE are very important differentiated who will has more risk of cardiovascular events. Methods and results: The present observational and prospective study included 22 patients with confirmed PE. Age 55 ± 15 years. We classificated in three groups: minor PE n = 9; PE + RVD n = 8; major PE n = 5. Elevated BNP › 500 pg/mL was significantly associated with mortality (P ‹ 0.001). The overall mortality was 18% and only in the major PE. Conclusions: The brain peptide natriuretic is a very important biomarker with a lot of utility in approach of patients with suspected pulmonary embolism.

KEYWORDS

PE (pulmonary embolism), BNP (brain natriuretic peptide), RVD (right ventricular dysfunction).

REFERENCES

1. British Thoracic Society Guidelines for the management of suspected acute pulmonary embolism. Thorax 2003; 53: 470-484.

2. Guidelines on diagnosis and management of acute pulmonary embolism. European Heart Journal 2000: 1301-1336.

3. Zippes D, Libby P, Bonow R, Braunwald E. Heart disease. Textbook of cardiovascular medicine. 7a Ed. USA. Elsevier Saunders. 2005: 1789.

4. Karwinski B, Suendsen E. Comparison of clinical and post mortem diagnosis of pulmonary embolism. J Clin Pathol 1989; 42(2): 135-9.

5. De Jesus Villagomez, Alcantar L, Avelar F, Ayala L; Bautista B. Guías para el Diagnóstico, Prevención y Tratamiento de la Enfermedad Tromboembólica Venosa. Revista del Colegio de Medicina Interna de México. 2006; 22 supl.1.

6. Pieralli F, Olivotto I, Vanni S. Usefulness of bedside testing for brain natriuretic peptide to identify right ventricular dysfunction and outcome in normotensive patients with acute pulmonary embolism. Am J Cardiol 2006; 97: 1386-1390.

7. Mills R. Measurement of B type natriuretic peptide in clinical practice: A critical appraisal. J Am Coll Cardiol Posted 12/03/2002.

8. ten Wolde M, Tulevski I, Molder J. Brain natriuretic peptide as a predictor of adverse outcome in patients with pulmonary embolism. Circulation 2003; 107: 2082-2084.

9. Sohne M, ten Wolde M, Buller H. Biomarkes in pulmonary embolism. Curr Opin Cardiol 2004; 19: 558-562.

10. Konstantinides S, Geibel A, Olschewski M. Importance of cardiac troponins I and T in risk stratification of patients with acute pulmonary embolism. Circulation 2002; 106: 1263-1268.

11. Metha N, Ketan J, Khan I. Clinical usefulness and prognostic value of elevated cardiac troponin I leves in acute pulmonary embolism. Am Heart J 2003; 145: 821-5.

12. Meyer T, Binder L, Hruska N. Cardiac troponin I elevation in acute pulmonary embolism is associated with right ventricular dysfunction. J Am Coll Cardiol 2002; 36: 1632-1636.

13. Horlander K, Leeper K. Troponin levels as a guide to treatment of pulmonary embolism. Curr Opin Pulm Med 2003; 9: 374-377.

14. Kucher N, Printzen G, Goldhaber S. Prognostic role of brain natriuretic peptide in acute pulmonary embolism. Circulation 2003; 107: 2545-2547.

15. Kline J, Hernandez-Nino J, Rose G. Surrogate markers for adverse outcomes in normotensive patients with pulmonary embolism. Crit Care Med 2006; 34: 2773-2780.

16. King L, Wilkins MR, et al. Natriuretic receptors an the heart. Heart 2002; 87: 314-316.

17. Bin Y, Mukerjee D, Timms P. Natriuretic peptides respiratory disease, and the right heart. Chest 2004; 126: 1330-1336.

18. Kruger S, Graf J, Merx M. Brain natriuretic peptide predicts right heart failure in patients with acute pulmonary embolism. Am Heart J 2004; 147: 60-5.

19. AlMahameed A, Bartholomew R. Patients with acute pulmonary embolism should have an echocardiogram to guide treatment decision. Med Clin N Am 2003; 87: 1251-1262.

20. Hung-Hsiao, Lee C, Chang S. Pulmonary embolism and right heart function: insights from myocardial Doppler tissue imaging. J Am Soc Echocardiogr 2006; 19: 822-828.

21. Kjaergaard J, Krogsgaard B, Lund J. Quantitative measures of right ventricular dysfunction by echocardiography in the diagnosis of acute non massive pulmonary embolism. J Am Soc Echocardiogr 2006; 19: 1264-1271.

22. Kucher N, Goldhaber S. Cardiac biomarkers for risk stratification of patients with acute pulmonary embolism. Circulation 2003; 108: 2191-2194.

23. Lang R, Bierig M, Devereux R, et al. Recommendations for chamber quantification: A Report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group. J Am Soc Echocardiogr 2005; 18: 1440-1463.

24. Kurzyna M, Torbicki A, Pruszczyk P. Disturbes right ventricular ejection pattern as a new Doppler echocardiographic sign of acute pulmonary embolism. Am J Cardiol 2002; 90: 507-511.

25. Giannitsis E, Katus H. Risk stratification in pulmonary embolism based on biomarkers and echocardiography. Circulation 2005; 112: 1520-1521.

26. Kluetz P, White C. Acute pulmonary embolism: Imaging in the Emergency Department. Radiol Clinics N Am 2006; 44: 259-71.

27. Piazza G, Goldhaber S. Acute pulmonary embolism. Circulation 2006; 114: e42-e47.

28. Ferrari E, Imbert A, Chevalier T, et al. The ECG in pulmonary embolism: Predictive value of negative T waves in precordial leads- 80 case reports. Chest 1997; 111(3): 537-543.

29. Ullman E, Brady W, Perron A, et al. Electrocardiographic manifestation of pulmonary embolism. American Journal of Emergency Medicine 2001; 19(6): 514-519.

30. Santos ME. Disfunción ventricular derecha en tromboembolia pulmonar. Neumología y Cirugía de Tórax 2005; 64: 63-71.