Research of Cardiac Biomarkers and Pulmonary Embolism Severity Index for the Diagnosis of Acute Pulmonary Embolism and Its Risk Stratification_West China Medical Journal

Authors：

 LIQun ¹ , WANGXiao-xia ¹ , GUOHong-xia ¹ ,  BAOYong ¹ , LIWei-min ²

1. Department of Respiratory Medicine, Second Affiliated Hospital, Chongqing Medical University, Chengdu, Sichuan 610031, P. R. China;
2. Department of Respiratory, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

BAOYong, Email: cd_baoyong@sina.com

Keywords：

Acute pulmonary embolism; Brain natriuretic peptide; Troponin I; Pulmonary embolism severity index; Diagnosis; Risk stratification

DOI：

10.7507/1002-0179.20140373

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Objective To investigate diagnostic and prognostic value of pulmonary embolism severity index (PESI), troponin I (cTnI) and brain natriuretic peptide (BNP) in patients with acute pulmonary embolism (APE). Methods A total of 96 patients confirmed with APE were collected from January 2010 to January 2013, and 50 cases of non-APE controls were also selected in the same period. According to the PESI scores, patients were divided into low-risk, mid-risk, and highrisk group. According to the results of cTnI and BNP, patients were divided into positive group and negative group. Then, we evaluated the diagnostic and prognostic value of the PESI score, cTnI and BNP for patients with APE. Results For the APE patients, the higher the risk was, the higher the constituent ratio of massive and sub-massive APE was (P<0.01). In the cTnI positive group, massive and sub-massive APE accounted for 82.9%, and in the cTnI negative group, non-massive APE was up to 81.9%; in the BNP positive group, massive and sub-massive APE accounted for 73.3%, and in the BNP negative group, non-massive APE was up to 86.3%. The patients with positive cTnI and BNP had a higher rate of right ventricular dysfunction, cardiogenic shock and mortality than the negative group (P<0.01). Conclusion The combined detection of cTnI, BNP and PESI score is important in the diagnosis and risk stratification in APE patients.

Citation： LIQun, WANGXiao-xia, GUOHong-xia, BAOYong, LIWei-min. Research of Cardiac Biomarkers and Pulmonary Embolism Severity Index for the Diagnosis of Acute Pulmonary Embolism and Its Risk Stratification. West China Medical Journal, 2014, 29(7): 1208-1212. doi: 10.7507/1002-0179.20140373 Copy

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25.	王洪兴, 张显峰, 佟倩. B型脑钠肽水平与急性肺栓塞严重性及预后的关系[J]. 中国老年学杂志, 2012, 32(4):812-813.
26.	Kurose M, Yosimura M, Yasue H. Raised plasma BNP in patients with pulmonary thromboembolism[J]. Heart, 1997, 78(3):320-321.
27.	Krüger S, Graf J, Merx MW, et al. Brain natriuretic peptide predicts right heart failure in patients with acute pulmonary embolism[J]. Am Heart J, 2004, 147(1):60-65.
28.	檀旦, 赵玉虹, 黄亚明. B型利钠肽对急性肺栓塞预后预测价值的Meta分析[J]. 中国循证医学杂志, 2011, 11(1):64-69.
29.	de Lemos JA, Mcguire DK, Drazner MH. B-type natriuretic peptide in cardiovascular disease[J]. Lancet, 2003, 362(9380):316-322.

1. Miniati M, Monti S, Bottai M, et al. Survival and restoration of pulmonary perfusion in a long-term follow-up of patients after acute pulmonary embolism[J]. Medicine, 2006, 85(5):253-262.
2. Konstantinides S, Kasper W. Pulmonary embolism[M]//Massie BM, Drexler H. Cardiology. London:Mosby International, 2001:18.1-18.10.
3. Carson JL, Kelley MA, Duff A, et al. The clinical course of pulmonary embolism[J]. N Engl J Med, 1992, 326(19):1240-1245.
4. Research Committee of the British Thoracic Society. Optimum duration of anticoagulation for deep-vein thrombosis and pulmonary embolism[J]. Lancet, 1992, 340(8824):873-876.
5. Jiménez D, Yusen RD, Otero R, et al. Prognostic models for selecting patients with acute pulmonary embolism for initial outpatient therapy[J]. Chest, 2007, 132(1):24-30.
6. Torbicki A, Perrier A, Konstantinides S, et al. Guidelines on the diagnosis and management of acute pulmonary embolism:the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC)[J]. Eur Heart J, 2008, 29(18):2276-2315.
7. 中华医学会呼吸病学分会. 肺血栓栓塞症的诊断与治疗指南(草案)[J]. 中华结核和呼吸杂志, 2001, 24(5):6-11.
8. PIOPED Investigators. Value of the ventilation/perfusion scan in acute pulmonary embolism. Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED)[J]. JAMA, 1990, 263(20):2753-2759.
9. Grifoni S, Olivotto I, Cecchini P, et al. Short-term clinical outcome of patients with acute pulmonary embolism, normal blood pressure, and echocardiographic right ventricular dysfunction[J]. Circulation, 2000, 101(24):2817-2822.
10. Giannitsis E, Katus HA. Risk stratification in pulmonary embolism based on biomarkers and echocardiography[J]. Circulation, 2005, 112(11):1520-1521.
11. Goldhaber SZ, Elliott CG. Acute pulmonary embolism:part Ⅱ:risk stratication, treatment, and prevention[J]. Circulation, 2003, 108(23):2834-2838.
12. Meyer T, Binder L, Hruska N, et al. Cardiac troponin I elevation in acute pulmonary embolism is associated with right ventricular dysfunction[J]. J Am Coll Cardiol, 2000, 36(5):1632-1636.
13. Katus HA, Remppis A, Neumann FJ, et al. Diagnostic efficiency of troponin T measurements in acute myocardial infarction[J]. Circulation, 1991, 83(3):902-912.
14. Mikulewicz M, Lewczuk J. Importance of cardiac biomarkers in risk stratification in acute pulmonary embolism[J]. Cardiology, 2008, 15(1):17-20.
15. Goldhaber SZ, Visani L, De Rosa M. Acute pulmonary embolism:clinical outcomes in the Inte rnational Cooperative Pulmonary Embolism Registry (ICOPER)[J]. Lancet, 1999, 353(9162):1386-1389.
16. Konstantinides S, Geibel A, Olschewski M, et al. Importance of cardiac troponins I and T in risk stratification of patients with acute pulmonary embolism[J]. Circulation, 2002, 106(10):1263-1268.
17. Horlander KT, Leeper KV. Troponin levels as a guide to treatment of pulmonary embolism[J]. Curr Opin Pulm Med, 2003, 9(5):374-377.
18. Alpert JS, Thygesen K, Antman E, et al. Myocardial infarction redefined——a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction[J]. J Am Coll Cardiol, 2000, 21(18):1502-1513.
19. Douketis JD, Leeuwenkamp O, Grobara P, et al. The incidence and prognostic significance of elevated cardiac troponins in patients with submassive pulmonary embolism[J]. J Thromb Haemost, 2005, 3(3):508-513.
20. Hamm CW, Giannitsis E, Katus HA. Cardiac troponin elevations in patients without acute coronary syndrome[J]. Circulation, 2002, 106(23):2871-2872.
21. Pruszczyk P, Bochowicz A, Torbicki A, et al. Cardiac troponin T monitoring identifies high-risk group of normotensive patients with acute pulmonary embolism[J]. Chest, 2003, 123(6):1947-1952.
22. Vogeser M, Jacob K. B-type natriuretic peptide (BNP)--validation of an immediate response assay[J]. Clin Lab, 2001, 47(1-2):29-33.
23. Hobbs FD, Davis RC, Roalfe AK, et al. Reliability of N-terminal probrain natriuretic peptide assay in diagnosis of heart failure:cohort study in representative and high risk community populations[J]. BMJ, 2002, 324(7352):1498.
24. Berger R, Huelsman M, Strecker K, et al. B-type natriuretic peptide predicts sudden death in patients with chronic heart failure[J]. Circulation, 2002, 105(20):2392-2397.
25. 王洪兴, 张显峰, 佟倩. B型脑钠肽水平与急性肺栓塞严重性及预后的关系[J]. 中国老年学杂志, 2012, 32(4):812-813.
26. Kurose M, Yosimura M, Yasue H. Raised plasma BNP in patients with pulmonary thromboembolism[J]. Heart, 1997, 78(3):320-321.
27. Krüger S, Graf J, Merx MW, et al. Brain natriuretic peptide predicts right heart failure in patients with acute pulmonary embolism[J]. Am Heart J, 2004, 147(1):60-65.
28. 檀旦, 赵玉虹, 黄亚明. B型利钠肽对急性肺栓塞预后预测价值的Meta分析[J]. 中国循证医学杂志, 2011, 11(1):64-69.
29. de Lemos JA, Mcguire DK, Drazner MH. B-type natriuretic peptide in cardiovascular disease[J]. Lancet, 2003, 362(9380):316-322.

West China Medical Journal

Research of Cardiac Biomarkers and Pulmonary Embolism Severity Index for the Diagnosis of Acute Pulmonary Embolism and Its Risk Stratification

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