Persistent NT-proBNP elevation in acute pulmonary embolism predicts early death

Area of Science:

• Cardiology
• Pulmonary Medicine
• Biomarkers

Background:

• N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels on admission are useful for identifying low-risk acute pulmonary embolism (APE) patients.
• However, elevated NT-proBNP levels lack specificity for identifying high-risk APE patients due to low positive predictive value (PPV).

Purpose of the Study:

• To evaluate if serial NT-proBNP measurements improve the PPV for mortality prediction in APE patients.
• To assess the prognostic value of NT-proBNP changes within 24 hours of APE diagnosis.

Main Methods:

• Prospective study of 113 consecutive APE patients.
• Serial NT-proBNP measurements were taken on admission, at 12 hours, and at 24 hours.
• Thirty-day mortality was assessed.

Main Results:

• In survivors, median NT-proBNP levels decreased significantly within 24 hours (p<0.001).
• In non-survivors, median NT-proBNP levels remained elevated at 24 hours (p=NS).
• Patients with NT-proBNP >7500 ng/L and <50% decrease within 24 hours had a 61% 30-day mortality rate, with a PPV of 61% and NPV of 94% for this combined criterion.

Conclusions:

• Persistent elevation of plasma NT-proBNP within 24 hours after APE diagnosis signifies ongoing right ventricular dysfunction and poor prognosis.
• These findings suggest that critically ill APE patients with persistent NT-proBNP elevation may benefit from rapid, aggressive interventions.
• Potential interventions include thrombolysis, catheter thrombectomy, or surgical embolectomy.