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Ozsu S * , Karaman K ** ,Mentese A *** ,Ozsu A **** , Karahan C *** , * Ozlu T

Right ventricular dysfunction and biomarkers: Risk stratification in normotensive patients with pulmonary embolism. Ozsu S * , Karaman K ** ,Mentese A *** ,Ozsu A **** , Karahan C *** , * Ozlu T .Karadeniz Technical University, * Department of Chest Disease ,

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Ozsu S * , Karaman K ** ,Mentese A *** ,Ozsu A **** , Karahan C *** , * Ozlu T

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  1. Right ventricular dysfunction and biomarkers: Risk stratification in normotensive patients with pulmonary embolism. Ozsu S *, Karaman K ** ,Mentese A ***,Ozsu A**** , Karahan C *** , *Ozlu T .Karadeniz Technical University, *Department of Chest Disease , ** Cardiology, ***Biochemistry **** Radiology

  2. Introduction-1 • In PE hemodynamic status independent risk factors • PE with massive,mortality 21-58 % • PE with non-massive, 2-15% • Right ventricular dysfunction (RVD) detected by computed tomography /echocardiography or elevated biomarkers are associated with worse prognosis in PE Goldhaber,Lancet 1999 Sanchez,Eur Heart J,2008

  3. Introduction-2 • elevated troponin levels were associated with a 8-fold increased risk of all-cause death • NT-proBNP levels were associated with a 6-fold increased risk of all-cause death • RVD echocardiographic 2-fold • RVD and combination of biomarker 10-12-fold Binder,Circulation,2005 Sanchez,Eur Heart J,2008

  4. Aim Within the literature, no previous study of PE patients has examined combinations of RVD detected by CT/echocardiography and elevated biomarkers(NT-proBNP, cTnT,IMAin the same patient population. We designed a study to evaluate the effect of these prognostic factors in patients with normotensive PE

  5. Material-method-1 • The study prospectively enrolled 108 consecutive patients with acute PE between October 2008 and December 2009 who were diagnosed by spiral Thorax CT. All investigated subjects presented systemic systolic blood pressure) ≥ 90 mmHg and diastolic blood pressure ≥ 60 mmHg. On admission was assayed cardiac Troponin T (cTnT). Samples for pro-BNP and IMA were immediately centrifuged, frozen and stored at -80°C.

  6. Material-method-2 • The examinations were performed and recorded within 24 h after admission by an echocardiographer and end diastolic RV/LV ratio was calculated. On Thorax CT ventricular diameters (RV/LV ratio) were identified as the maximum distance. • RVD was determined; on CT RV/LV>1 and On echo RV-enddiastolik diamater>30mm • All patients follow-up during one months

  7. Table- 1. *Characteristics of the patients with PE

  8. Results • All cause 30-day mortality 13% (14 pts) and PE-related mortality 5.6 % (6 pts) were. • cTnT, proBNP and IMA of cut-off value, ≥0.027 ng/ml, ≥300 pmol/ml and 0.8 ABSU, respectively for all mortality were found.

  9. Univariate Cox analysis • NT-proBNP > 300 overall death 14 fold • Tn-T≥0.027 overall death 14.5 • Tn-T≥ 0.027 ng/ml and on echo RVD of combination PE-related death 14-fold,overall death 37.6 kat • There was no significant on CT/echo RVD for all deaths • There was no significant combination of IMA with RVD on CT/echocardiography for all deaths

  10. Multivariable Cox’s regresyon analizinde tüm mortalite için biyomarker ve RVD’nun (CT ve ekoda) kombinasyonu

  11. 108 patients(pts) 94 alive 14 all deaths 6 PE deaths Tnt≥0.027 25 pts 11 deaths 6 PE deaths proBNP>300 16 pts 9 deaths 6 PE deaths 14 pts 9 deaths 6 PE deaths High risk 64.3 % 64.3% all death + TnT<0.027 58 pts 55 alive zero PE death proBNP≤300 93 pts 5 death zero PE death 94 pts 89 alive 5 deaths zero PE death Intermediate risk %5.3 35.7% all death + proBNP≤90 55pts 54 alive Zero PE death Low risk %1.8 7.1% all deaths Risk stratification in patients with normotensive PE

  12. Discussion-1 • ¹Kostrubiec, who reported that mortality rate for combination of Tn-T>0.07 µg/ml and NT-proBNP>600 ng/ml was 50%. • ²Tulevski,found that mortality in BNP>10 pmol/L and Tn-T>0.010 ng/ml combination was 33% • ³Binder,have shown that adverse outcome increased 10-fold elevated troponin combined with echocardiographic RVD • ¹Eur Heart J 2005 • ²Int J Cardiol 2007 • ³Circulation,2005

  13. Discussion-2 • NT-proBNP was associated with good prognosis of PE • Negative predictive value of NT-proBNP for mortality differs between 97 and 100 %. • In our study, the specificity of a NT-proBNP value ≤ 90 for survival was 93% and that of NPV for mortality was 98%.

  14. Discussion-3 • We recommend that it is better to consider thrombolytic therapy options in high-risk patients identified by combination of Tn-T and NT-proBNP • Low NT-proBNP can be used as an important criterion for the selection of outpatient treatments.

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