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Thromb Haemost 2001; 86(05): 1193-1196
DOI: 10.1055/s-0037-1616050
Review Article
Schattauer GmbH

Increased Brain Natriuretic Peptide as a Marker for Right Ventricular Dysfunction in Acute Pulmonary Embolism

Igor I. Tulevski
1   Departments of Cardiology, The Netherlands
,
Alexander Hirsch
1   Departments of Cardiology, The Netherlands
,
Bernd-Jan Sanson
2   Internal Medicine, Academic Medical Center Amsterdam, The Netherlands
,
Hans Romkes
1   Departments of Cardiology, The Netherlands
,
Ernst E. van der Wall
3   Department of Cardiology, Leiden University Medical Center, The Netherlands
,
Dirk J. van Veldhuisen
4   Department of Cardiology, University Hospital Groningen, The Netherlands
,
Harry R. Büller
2   Internal Medicine, Academic Medical Center Amsterdam, The Netherlands
,
Barbara J. M. Mulder
1   Departments of Cardiology, The Netherlands
› Author AffiliationsIgor I. Tulevski is supported by the Netherlands Heart Foundation (NHS) and Interuniversity Cardiology Institute of the Netherlands (ICIN-KNAW). Dirk J. van Veldhuisen is a Clinical Established Investigator of the NHS
Igor I. Tulevski is supported by the Netherlands Heart Foundation (NHS) and Interuniversity Cardiology Institute of the Netherlands (ICIN-KNAW). Dirk J. van Veldhuisen is a Clinical Established Investigator of the NHS
Further Information

Publication History

Received 19 March 2001

Accepted after resubmission 18 July 2001

Publication Date:
13 December 2017 (online)

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Summary

Right ventricular (RV) function is of major prognostic significance in patients with acute pulmonary embolism (PE). The aim of the present study was to evaluate the role of neurohormone plasma brain natriuretic peptide (BNP) in assessing RV function in patients with acute PE.

BNP levels were measured in 16 consecutive patients with acute PE as diagnosed by high probability lung scintigraphy or pulmonary angiography. Twelve healthy age-matched volunteers served as controls. All 16 patients underwent standard echocardiography and blood tests during the first hour of presentation. In the patient group, survival was studied for a period of 30 days. Plasma BNP levels in patients with acute PE were higher than in controls (7.2 [95% CI 0.4 to 144.6] versus 1.4[95% CI 0.4 to 4.6] pmol/L, p = 0.0008). Plasma BNP was significantly higher in 5 patients with RV dysfunction compared to 11 patients with normal RV function (40.2 [95% CI 7.5 to 214.9] versus 3.3 [95% CI 0.4 to 24.9] pmol/L, p = 0.0003). RV systolic pressure was not significantly correlated with BNP (r = 0.42, p = ns).

In conclusion, plasma BNP neurohormone levels might be of clinical importance as a supplementary tool for assessment of RV function in patients with acute PE.

Keywords

Acute pulmonary embolism - right ventricular function - brain natriuretic peptide
 

  • References

  • 1 Torbicki A, van Beek EJR, Charbonnier B, Meyer G, Morpurgo M, Palla A, Perrier A, Galie N, Gorge G, Herold C, Husted S, Jezek V, Kasper W, Kneussl M, Morice AH, Musset D, Samama MM, Simonneau G, Sors H, de Swiet M, Turina M, Kronik G, Widimsky J. Guidelines on diagnosis and management of acute pulmonary embolism. Eur Heart J 2000; 21: 1301-36.
    CrossrefPubMedGoogle Scholar
  • 2 Ribeiro A, Juhlin-Dannfelt A, Brodin LA, Holmgren A, Jorfeldt L. Pulmonary embolism: relation between the degree of right ventricle overload and the extent of perfusion defects. Am Heart J 1998; 135: 868-74.
    CrossrefPubMedGoogle Scholar
  • 3 Goldhaber SZ, Haire WD, Feldstein ML, Miller M, Toltzis R, Smith JL, Taveira da Silva AM, Come PC, Lee RT, Parker JA. Alteplase versus heparin in acute pulmonary embolism: randomised trial assessing right-ventricular function and pulmonary perfusion. Lancet 1993; 341: 507-11.
    CrossrefPubMedGoogle Scholar
  • 4 Konstantinides S, Geibel A, Olschewski M, Heinrich F, Grosser K, Rauber K, Iversen S, Redecker M, Kienast J, Just H, Kasper W. Association between thrombolytic treatment and the prognosis of hemodynamically stable patients with major pulmonary embolism: results of a multicenter registry. Circulation 1997; 96: 882-8.
    CrossrefPubMedGoogle Scholar
  • 5 Kasper W, Konstantinides S, Geibel A, Tiede N, Krause T, Just H. Prognostic significance of right ventricular afterload stress detected by echocardiography in patients with clinically suspected pulmonary embolism. Heart 1997; 77: 346-9.
    CrossrefPubMedGoogle Scholar
  • 6 Grifoni S, Olivotto I, Cecchini P, Pieralli F, Camaiti A, Santoro G, Conti A, Agnelli G, Berni G. Short-term clinical outcome of patients with acute pulmonary embolism, normal blood pressure, and echocardiographic right ventricular dysfunction. Circulation 2000; 101: 2817-22.
    CrossrefPubMedGoogle Scholar
  • 7 Goldhaber SZ. Pulmonary embolism for cardiologists. J Am Coll Cardiol 1997; 30: 1172-3.
    CrossrefPubMedGoogle Scholar
  • 8 Tulevski II, Groenink M, Van der Wall EE, van Veldhuisen DJ, Boomsma F, Stoker J, Mulder BJM. Increased Brain and Atrial Natriuretic Peptides in Patients with Chronic Right Ventricular Pressure Overload: Correlation between Plasma Neurohormones and Right Ventricular Dysfunction. Heart 2001; 86: 27-30.
    CrossrefPubMedGoogle Scholar
  • 9 Nagaya N, Nishikimi T, Okano Y, Uematsu M, Satoh T, Kyotani S, Kuribayashi S, Hamada S, Kakishita M, Nakanishi N, Takamiya M, Kunieda T, Matsuo H, Kangawa K. Plasma brain natriuretic peptide levels increase in proportion to the extent of right ventricular dysfunction in pulmonary hypertension. J Am Coll Cardiol 1998; 31: 202-8.
    CrossrefPubMedGoogle Scholar
  • 10 Nootens M, Kaufmann E, Rector T, Toher C, Judd D, Francis GS, Rich S. Neurohormonal activation in patients with right ventricular failure from pulmonary hypertension: relation to hemodynamic variables and endothelin levels. J Am Coll Cardiol 1995; 26: 1581-5.
    CrossrefPubMedGoogle Scholar
  • 11 McDonagh TA, Robb SD, Murdoch DR, Morton JJ, Ford I, Morrison CE, Tunstall-Pedoe H, McMurray JJ, Dargie HJ. Biochemical detection of left-ventricular systolic dysfunction. Lancet 1998; 351: 9-13.
    CrossrefPubMedGoogle Scholar
  • 12 Richards AM, Nicholls MG, Yandle TG, Frampton C, Espiner EA, Turner JG, Buttimore RC, Lainchbury JG, Elliott JM, Ikram H, Crozier IG, Smyth DW. Plasma N-terminal pro-brain natriuretic peptide and adrenomedullin: new neurohormonal predictors of left ventricular function and prognosis after myocardial infarction. Circulation 1998; 97: 1921-9.
    CrossrefPubMedGoogle Scholar
  • 13 Van Veldhuisen DJ, Boomsma F, de Kam PJ, Man in’t Veld AJ, Crijns HJ, Hampton JR, Lie KI. Influence of age on neurohormonal activation and prognosis in patients with chronic heart failure. Eur Heart J 1998; 19: 753-60.
    CrossrefPubMedGoogle Scholar
  • 14 Mukoyama M, Nakao K, Hosoda K, Suga S, Saito Y, Ogawa Y, Shirakami G, Jougasaki M, Obata K, Yasue H. Brain natriuretic peptide as a novel cardiac hormone in humans. Evidence for an exquisite dual natriuretic peptide system, atrial natriuretic peptide and brain natriuretic peptide. J Clin Invest 1991; 87: 1402-12.
    CrossrefPubMedGoogle Scholar
  • 15 Kambayashi Y, Nakao K, Kimura H, Kawabata T, Nakamura M, Inouye K, Yoshida N, Imura H. Biological characterization of human brain natriuretic peptide (BNP) and rat BNP: species-specific actions of BNP. Biochem Biophys Res Commun 1990; 173: 599-605.
    CrossrefPubMedGoogle Scholar
  • 16 Hama N, Itoh H, Shirakami G, Nakagawa O, Suga S, Ogawa Y, Masuda I, Nakanishi K, Yoshimasa T, Hashimoto Y. Rapid ventricular induction of brain natriuretic peptide gene expression in experimental acute myocardial infarction. Circulation 1995; 92: 1558-64.
    CrossrefPubMedGoogle Scholar
  • 17 Kurose M, Yoshimura M, Yasue H. Raised plasma BNP in a patient with acute pulmonary thromboembolism. Heart 1997; 78: 320-1.
    PubMedGoogle Scholar
  • 18 Henry WL, DeMaria A, Gramiak R, King DL, Kisslo JA, Popp RL, Sahn DJ, Schiller NB, Tajik A, Teichholz LE, Weyman AE. Report of the american society of echocardiography committee on nomenclature and standards in two-dimensional echocardiography. Circulation 1980; 62: 212-5.
    CrossrefPubMedGoogle Scholar
  • 19 Ribeiro A, Lindmarker P, Juhlin-Dannfelt A, Johnsson H, Jorfeldt L. Echocardiography Doppler in pulmonary embolism: right ventricular dysfunction as a predictor of mortality rate. Am Heart J 1997; 134: 479-87.
    CrossrefPubMedGoogle Scholar
  • 20 Grifoni S, Olivotto I, Cecchini P, Pieralli F, Camaiti A, Santoro G, Pieri A, Toccafondi S, Magazzini S, Berni G, Agnelli G. Utility of an integrated clinical, echocardiographic, and venous ultrasonographic approach for triage of patients with suspected pulmonary embolism. Am J Cardiol 1998; 82: 1230-5.
    CrossrefPubMedGoogle Scholar
  • 21 Currie P, Seward J, Chan KL, Fyfe DA, Hagler DJ, Mair DD, Reeder GS, Nishimura RA, Tajik AJ. Continuous wave Doppler determination of right ventricular pressure: a simultaneous Doppler-catheterization study in 127 patients. J Am Coll Cardiol 1985; 6: 7500-6.
    PubMedGoogle Scholar
  • 22 Jardin F, Dubourg O, Bourdarias JP. Echocardiographic pattern of acute cor pulmonale. Chest 1997; 111: 209-17.
    CrossrefPubMedGoogle Scholar
  • 23 Giannitsis E, Muller-Bardorff M, Kurowski V, Weidtmann B, Wiegand U, Kampmann M. Katus HA Independent prognostic value of cardiac troponin T in patients with confirmed pulmonary embolism. Circulation 2000; 102: 211-7.
    CrossrefPubMedGoogle Scholar
  • 24 Lualdi JC, Goldhaber SZ. Right ventricular dysfunction after acute pulmonary embolism: pathophysiologic factors, detection, and therapeutic implications. Am Heart J 1995; 130: 1276-82.
    CrossrefPubMedGoogle Scholar
  • 25 Troughton RW, Frampton CM, Yandle TG, Espiner EA, Nicholls MG, Richards AM. Treatment of heart failure guided by plasma aminoterminal brain natriuretic peptide (N-BNP) concentrations. Lancet 2000; 355: 1126-30.
    CrossrefPubMedGoogle Scholar
  • 26 Tsutamoto T, Wada A, Maeda K, Hisanaga T, Mabuchi N, Hayashi M, Ohnishi M, Sawaki M, Fujii M, Horie H, Sugimoto Y, Kinoshita M. Plasma brain natriuretic peptide level as a biochemical marker of morbidity and mortality in patients with asymptomatic or minimally symptomatic left ventricular dysfunction – Comparison with plasma angiotensin II and endothelin-1. Eur Heart J 1999; 20: 1799-807.
    CrossrefPubMedGoogle Scholar
  • 27 Darbar D, Davidson NC, Gillespie N, Choy AM, Lang CC, Shyr Y, McNeill GP, Pringle TH, Struthers AD. Diagnostic value of B-type natriuretic peptide concentrations in patients with acute myocardial infarction. Am J Cardiol 1996; 78: 284-7.
    CrossrefPubMedGoogle Scholar
  • 28 Omland T, Aakvaag A, Bonarjee VV, Caidahl K, Lie RT, Nilsen DW, Sundsfjord JA, Dickstein K. Plasma brain natriuretic peptide as an indicator of left ventricular systolic function and long-term survival after acute myocardial infarction. Comparison with plasma atrial natriuretic peptide and N-terminal proatrial natriuretic peptide. Circulation 1996; 93: 1963-9.
    CrossrefPubMedGoogle Scholar