Helical computerized tomography and NT-proBNP for screening of right ventricular overload on admission and at long term follow-up of acute pulmonary embolism

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Pirjo Mustonen¹  Merja Raade²  Anneli Piilonen²  Marit Graner⁵  Veli-Pekka Harjola⁴  Mia K Laiho³ 

[1] Red Cross Blood Transfusion Service, Kivihaantie 7, 00310, Helsinki, Finland;Department of Radiology, Helsinki University Central Hospital, POB 340, 00029 HUS, Helsinki City, Finland;Helsinki Malmi City Hospital, Department of Emergency care, POB 6501, 00099, Helsinki City, Finland;Division of Emergency Care, Department of Medicine, Helsinki University Central Hospital, POB 340, 00029 HUS, Helsinki City, Finland;Division of Cardiology, Department of Medicine, Helsinki University Central Hospital, POB 340, 00029 HUS, Helsinki City, Finland

关键词: CT pulmonary angiography;    Echocardiography, helical CT;    NT-pro-BNP;    right ventricular dysfunction;    Follow-up;    Non-high risk pulmonary embolism;   

Others  :  826581
DOI  :  10.1186/1757-7241-20-33

 received in 2011-12-20, accepted in 2012-05-04,  发布年份 2012

【 摘 要 】

Background

Right ventricular dysfunction (RVD) in acute pulmonary embolism (APE) can be assessed with helical computerized tomography (CT) and transthoracic echocardiography (TTE). Signs of RVD and elevated natriuretic peptides like NT-proBNP and cardiac troponin (TnT) are associated with increased risk of mortality. However, the prognostic role of both initial diagnostic strategy and the use of NT-proBNP and TnT for screening for long-term probability of RVD remains unknown. The aim of the study was to determine the role of helical CT and NT-proBNP in detection of RVD in the acute phase. In addition, the value of NT-proBNP for ruling out RVD at long-term follow-up was assessed.

Methods

Sixty-three non-high risk APE patients were studied. RVD was assessed at admission in the emergency department by CT and TTE, and both NT-proBNP and TnT samples were taken. These, excepting CT, were repeated seven months later.

Results

At admission RVD was detected by CT in 37 (59 %) patients. RVD in CT correlated strongly with RVD in TTE (p < 0.0001). NT-proBNP was elevated (≥ 350 ng/l) in 32 (86 %) patients with RVD but in only seven (27 %) patients without RVD (p < 0.0001). All the patients survived until the 7-month follow-up. TTE showed persistent RVD in 6 of 63 (10 %) patients who all had RVD in CT at admission. All of them had elevated NT-proBNP levels in the follow-up compared with 5 (9 %) of patients without RVD (p < 0.0001).

Conclusions

TTE does not confer further benefit when helical CT is used for screening for RVD in non-high risk APE. All the patients who were found to have RVD in TTE at seven months follow-up had had RVD in the acute phase CT as well. Thus, patients without RVD in diagnostic CT do not seem to require further routine follow-up to screen for RVD later. On the other hand, persistent RVD and thus need for TTE control can be ruled out by assessment of NT-proBNP at follow-up. A follow-up protocol based on these findings is suggested.

【 授权许可】

   
2012 Laiho et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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