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European Heart Journal Advance Access published online on May 23, 2005
European Heart Journal, doi:10.1093/eurheartj/ehi336
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European Heart Journal © The European Society of Cardiology 2005; all rights reserved
Received December 5, 2004
Revised March 20, 2005
Accepted April 28, 2005

Clinical research

Biomarker-based risk assessment model in acute pulmonary embolism

Maciej Kostrubiec 1, Piotr Pruszczyk 1*, Anna Bochowicz 1, Ryszard Pacho 2, Marcin Szulc 1, Anna Kaczynska 1, Grzegorz Styczynski 1, Agnieszka Kuch-Wocial 1, Piotr Abramczyk 1, Zbigniew Bartoszewicz 3, Hanna Berent 1, and Krystyna Kuczynska 1

1 Department of Internal Medicine, Hypertension and Angiology, The Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland
2 Department of Radiology, The Medical University of Warsaw, Warsaw, Poland
3 Department of Endocrinology, The Medical University of Warsaw, Warsaw, Poland

* To whom correspondence should be addressed.
Piotr Pruszczyk, E-mail: piotr.pruszczyk{at}amwaw.edu.pl


  Abstract

Aims Despite growing interest in biomarkers application for risk evaluation in acute pulmonary embolism (APE), no decision-making levels have been defined.

Methods and results We developed a biomarker-based risk stratification in 100 consecutive, normotensive on admission, APE patients (35 males, 65 females, 62±18 years). On admission serum NT-proBNP and cardiac troponin T (cTnT) levels were assessed and echocardiography was performed. All-cause 40-day mortality was 15% and APE mortality was 8%. In univariable analysis, cTnT > 0.07 µg/L predicted all-cause mortality, hazard ratio (HR) 9.2 (95% CI: 3.3-26.1, P < 0.0001), and APE mortality, HR 18.1 (95% CI: 3.6-90.2, P = 0.0004); similarly, NT-proBNP > 7600 ng/L predicted all-cause and APE mortalities [HR 6.7 (95% CI: 2.4-19.0, P = 0.0003) and 7.3 (95% CI: 1.7-30.6, P = 0.007)]. NT-proBNP < 600 ng/L indicated uncomplicated outcome. Multivariable analysis revealed that cTnT > 0.07 µg/L was the most significant independent predictor, whereas NT-proBNP and systemic systolic blood pressure measured on admission and echocardiographic parameters were non-significant. APE mortality in patients with NT-proBNP ≥ 600 ng/L and cTnT ≥ 0.07 µg/L reached 33%. NT-proBNP < 600 ng/L indicated group without deaths. APE mortality for patients with NT-proBNP ≥ 600 ng/L and cTnT < 0.07 µg/L was 3.7%. Incorporation of echocardiographic data did not improve group selection.

Conclusion Simultaneous measurement of serum cTnT and NT-proBNP allows for precise APE prognosis. Normotensive patients on admission with cTnT ≥ 0.07 µg/L and NT-proBNP ≥ 600 ng/L are at high risk of APE mortality, whereas NTproBNP < 600 ng/L indicates excellent prognosis.

Keywords: Pulmonary embolism; Brain natriuretic peptide; Troponin; Echocardiography; Prognosis; Mortality.
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