Biomarker-based strategy for screening right ventricular dysfunction in patients with non-massive pulmonary embolism

To evaluate the usefulness of B-type natriuretic peptide and troponin I measurements in predicting right ventricular dysfunction (RVD) in non-massive pulmonary embolism.

Prospective observational study.

University-affiliated emergency unit, cardiology and pneumology departments.

Sixty-seven patients admitted because of acute pulmonary embolism, without shock on admission, completed the study.

Blood samples and echocardiography were obtained on admission for subsequent and independent assessment of B-type natriuretic peptide (BNP) and troponin I levels as well as RVD.

Echocardiographic RVD was diagnosed in 36 patients and was severe in 13 on admission. BNP and troponin I levels were higher in patients with RVD than in those with no RVD [62 (27-105) vs. 431 (289-556) pg/ml for BNP, p<0.001; 0.01 (0-0.09) vs. 0.16 (0.03-0.32) microg/l for troponin I, p=0.005]. The area under the receiving operating characteristic curve (AUC) for diagnosing RVD was 0.93 for BNP and 0.72 for troponin I. The troponin I level increased further when RVD was severe, compared with moderate, and the AUC was 0.91 for identifying severe RVD. Diagnoses of RVD and severe RVD were ruled out by BNP100 pg/ml and troponin I >0.10 microg/l.

In hemodynamically stable pulmonary embolism, BNP/troponin I measurement is helpful on admission, especially for ruling out RVD, i.e. patients with in-hospital high-risk.