Brief ReportEvaluation of B-type natriuretic peptide to predict complicated pulmonary embolism in patients aged 65 years and older: brief report
Introduction
Accurate risk stratification is of paramount importance in selecting the optimal management strategy for patients with acute pulmonary embolism (PE) [1], [2], [3], [4]. Rapid, noninvasive, and accurate prognostic assessment with an inexpensive and widely available cardiac biomarker is an appealing approach. The cardiac myocytes can excrete several biomarkers when they are stretched or injured (eg, troponins I and T, B-type natriuretic peptide [BNP]). Although the release of troponins only occurs with degradation of the cardiac myocyte, the secretion of BNP is stimulated upon stretch of mainly the ventricular myocytes, especially in congestive heart failure [5], [6], [7]. Several studies have demonstrated that BNP or N-terminal pro-BNP (NT-pro-BNP) and troponins (T or I) are released during the early stage of massive PE-associated myocardial strain [8], [9], [10], [11], [12], [13], [14], [15], [16], but they evaluated the usefulness of BNP in risk stratification of PE only in middle-aged patients. However, higher natriuretic peptide levels have been observed in elderly patients [6], [7]. Therefore, we studied the use of plasma BNP levels for risk stratification in patients older than 65 years with acute PE.
Section snippets
Patients and methods
This prospective study took place in a medical ED of an urban teaching hospital with 1800 beds from September 2001 to April 2003. We obtained blood samples for BNP testing within the admission of consecutive patients older than 65 years with acute PE. The local ethics committee approved the study protocol (Comité Consultatif Pour les Personnes se prêtant à une Recherche Biomédicale), and waived informed consent was authorized because routine care of the patient was not modified.
The final
Results
From April 2001 to April 2003, we obtained blood samples for BNP testing within the admission in 51 consecutive patients older than 65 years with confirmed acute PE. The mean age was 79 ± 9 years (extremes, 65-100), 32 patients (63%) were older than 75 years, and there were 33 women and 18 men. The risk factors for venous thromboembolic diseases (VTEDs) were previous hospitalization less than 3 months in 19 (37%), personal history of VTED in 15 (29%), solid malignancy in 12 (24%), chronic
Discussion
To our knowledge, this is the first study that evaluated the usefulness of BNP in risk stratification of PE in patients older than 65 years. We confirmed that median BNP level was higher in the group of patients with right heart failure, and that median BNP level was higher in the group of complicated PE. However, we observed that BNP was not an accurate test to identify patients with a low risk of complicated PE in elderly patients (AUC of 0.72, with a sensitivity of 0.69 and a specificity of
Acknowledgments
This study was supported solely by departmental sources. The test and kits for BNP assay were provided free of charges by Biosite USA. The study sponsor has no involvement in the study design, in the collection and analysis of the data, and in the writing of the report. The manuscript was not submitted to Biosite. The authors thank the physicians and nursing staff working in the ED and all the physicians of the EPIDASA study group, Dr M-H Becquemin, Dr C Beigelman, Dr M Bennaceur, Dr S
References (17)
- et al.
Brain natriuretic peptide predicts right heart failure in patients with acute pulmonary embolism
Am Heart J
(2004) - et al.
Clinical usefulness and prognostic value of elevated cardiac troponin I levels in acute pulmonary embolism
Am Heart J
(2003) - et al.
Cardiac troponin T monitoring identifies high-risk group of normotensive patients with acute pulmonary embolism
Chest
(2003) - et al.
Heparin plus alteplase compared with heparin alone in patients with submassive pulmonary embolism
N Engl J Med
(2002) - et al.
Importance of cardiac troponins I and T in risk stratification of patients with acute pulmonary embolism
Circulation
(2002) Guidelines on diagnosis and management of acute pulmonary embolism
Eur J Heart
(2000)Echocardiography in the management of pulmonary embolism
Ann Intern Med
(2002)- et al.
Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure
N Engl J Med
(2002)