Document Detail


Brain natriuretic peptide as a preclinical marker of chronic pulmonary hypertension in patients with pulmonary embolism.
MedLine Citation:
PMID:  19247590     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Chronic thromboembolic pulmonary hypertension (CTPH) is a potential complication of pulmonary embolism (PE). Only few studies have assessed the role of brain natriuretic peptide (BNP) in patients with chronic pulmonary hypertension, and there are no data on the potential utility of BNP as a preclinical biomarker of CTPH. To assess the correlation between pulmonary artery systolic pressures (PAPs) and amino terminal proBNP (Nt-proBNP) and its value in the diagnosis of CTPH in patients with previous PE. Patients were evaluated with echocardiography at least 6 months after the index event. Pulmonary hypertension was defined as PAPs > or =40 mmHg at rest. Each subject underwent measurement of Nt-proBNP. Forty-nine patients were enrolled (mean age 64.5 +/- 13.1 years; 22 men). Seven patients had CTPH, and two were symptomatic. There was a good correlation between PAP on echocardiography and Nt-proBNP (r 0.64; P = 0.00003). Nt-proBNP was elevated in 6 of 7 patients [sensitivity: 85.7%; 95% confidence interval (CI): 48.7, 97.4] and it was normal in 35 of 42 patients without CTPH (specificity: 76.2%; 95% CI: 61.5, 86.5%). Six of the 13 patients with high Nt-proBNP levels had CTPH, whereas 1 of 36 patients with normal Nt-proBNP levels had pulmonary hypertension. The resulting positive predictive value was 46.1% (95% CI: 19.2, 74.9), and the negative predictive value was 97.2% (95% CI: 85.5-99.9). In conclusion, Nt-proBNP correlates with PAPs and may be used to exclude preclinical or symptomatic CTPH in patients with previous PE. Prospective studies on a larger population are warranted to confirm our preliminary findings.
Authors:
Francesco Dentali; Marco Donadini; Monica Gianni; Andrea Bertolini; Eva Lonn; Achille Venco; Gianpaolo Cattozzo; Walter Ageno
Publication Detail:
Type:  Journal Article     Date:  2009-02-27
Journal Detail:
Title:  Internal and emergency medicine     Volume:  4     ISSN:  1970-9366     ISO Abbreviation:  Intern Emerg Med     Publication Date:  2009 Apr 
Date Detail:
Created Date:  2009-03-17     Completed Date:  2009-07-31     Revised Date:  2010-06-07    
Medline Journal Info:
Nlm Unique ID:  101263418     Medline TA:  Intern Emerg Med     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  123-8     Citation Subset:  IM    
Affiliation:
Department of Clinical Medicine, University of Insubria, Varese, Italy. fdentali@libero.it
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MeSH Terms
Descriptor/Qualifier:
Aged
Biological Markers
Chronic Disease
Female
Humans
Hypertension, Pulmonary / diagnosis*
Longitudinal Studies
Male
Middle Aged
Natriuretic Peptide, Brain / analysis,  secretion*
Peptide Fragments
Pulmonary Embolism / complications*
Chemical
Reg. No./Substance:
0/Biological Markers; 0/Peptide Fragments; 0/pro-brain natriuretic peptide (1-76); 114471-18-0/Natriuretic Peptide, Brain
Comments/Corrections
Comment In:
Intern Emerg Med. 2009 Oct;4(5):443-4   [PMID:  19655224 ]
Intern Emerg Med. 2009 Oct;4(5):439; author reply 441-2   [PMID:  19468826 ]

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