PULMONARY EMBOLISM Prognostic value of brain natriuretic peptide and troponin I in moderate and high risk pulmonary embolism Received: 27/06/2011 Accepted: 26/03/2012 Address for reprints: Dr. Guillermo Jaimovich Hospital Italiano de Buenos Aires Perón 4190 (C1199ABB) Ciudad Autónoma de Buenos Aires Tel. 54 11 4959-0200 int. 8782 Fax 54 11 4958-2623 e-mail: guillermo.jaimovich@hospitalitaliano. org.ar ABSTRACT Department of Cardiology, Instituto de Medicina Cardiovascular, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina MTSAC Full Member of the Argentine Society of Cardiology 1 MD, Cardiologist 2 MD, Cardiology Resident 3 Staff MD at the Department of Cardiology 4 Head of the Cardiac Imaging Section 5 Head of the Coronary Care Unit 6 Head of the Department of Cardiology GUILLERMO JAIMOVICH 1 , JUAN BENGER 2 , WALTER M. MASSON MTSAC, 1, 3 , MAURO L. GIACOMINI 1 , PABLO F. OBERTI MTSAC, 1, 4 , JOSÉ L. NAVARRO ESTRADA MTSAC, 1, 5 , ARTURO M. CAGIDE MTSAC, 1, 6 Key words > Pulmonary Embolism - Brain Natriuretic Peptide - Troponin – Risk stratification Background Brain natriuretic peptide (BNP) and troponins are useful markers for risk stratification in pulmonary embolism (PE). However, it is not clear which of the two biomarkers has better association with the clinical severity of this condition. Objective The aim of this study was to assess both biomarkers in moderate and high risk populations. Methods A prospective study was undertaken to analyze all patients diagnosed with PE who had positive troponin I (TI) or BNP levels. An echocardiogram within the first 24 hours and clinical follow up during hospitalization were performed on these patients. A composite endpoint of death, recurrent PE, shock, hypotension, mechanical respiratory assistance and thrombolytic therapy was established. The association of both serum markers with the described events was assessed. Results Seventy one consecutive patients were included in this study. Patients with moderate or severe right ventricular dysfunction had higher BNP levels (661 pg/ml (420-1113) vs. 316 pg/ml (129-570) p=0.002) without significant difference in TI levels (0.115 ng/ml (0.015-0.345) vs. 0.24 ng/ml (0.076-0.58) p=0.0788). BNP levels were higher in patients with composite endpoint [604 pg/ml (370-934) vs. 316 pg/ml (148-900) p=0.042], whereas no similar association was found for TI [0.12 ng/ml (0.037-0.48) vs. 0.13 ng/ml (0.07-0.41) p=0.46]. Conclusions BNP showed higher values in patients with right ventricular dysfunction and composite endpoint, indicating its greater sensitivity to identify patients with more severe clinical involvement. REV ARGENT CARDIOL 2012;80:292-298. http://dx.doi.org/10.7775/rac.v80.i4.1329 Abbreviations > BNP Brain natriuretic peptide RVD Right ventricular dysfunction ACE Adverse clinical events NT-proBNP N-terminal pro-brain natriuretic peptide PE Pulmonary embolism TI Troponn I SEE RELATED ARTICLE: http://dx.doi.org/10.7775/rac.v80.i4.1486 Rev Argent Cardiol 2012;80:271-2