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Cardiac biomarkers for risk stratification in non-massive pulmonary embolism: a multicenter prospective study.
J Thromb Haemost. 2009 Mar; 7(3):391-8.JT

Abstract

BACKGROUND

Troponins (cTnI and cTnT), N-terminal pro-Brain Natriuretic Peptide (NT-proBNP), myoglobin, heart-type fatty acid-binding protein (H-FABP) and fibrin D-Dimer are emergent candidates for risk stratification in pulmonary embolism (PE).

OBJECTIVE

To compare the respective prognostic values of biomarker with non-massive PE to predict an adverse outcome at 3 months.

PATIENTS/METHODS

One hundred and forty-six consecutive patients with non-massive PE were included in this multicenter prospective study. The combined outcome consisted of intensive care monitoring on admission, death or hospitalization attributable to either a PE-related complication [defined by PE/deep vein thrombosis (DVT) relapse or major bleeding under anticoagulation] or to dyspnoea with or without chest pain during follow-up.

RESULTS

The outcome was met in 12% of patients. In univariate analysis, a NT-proBNP level above 300 pg/ml was the strongest predictor of unfavorable outcome with an odds ratio (OR) of 15.8 [95% confidence interval (CI): 2.05-122). ORs for the other variables were: 8.0 for D-dimer >2000 ng/ml (95% CI: 1.1-64), 4.7 for H-FABP >6 ng/ml (95% CI:1.5-14.8), 3.5 for cTnI >0.09 ng/ml (95% CI:1.2-9.7), 3.4 for myoglobin >70 ng/ml (95% CI:0.9-12.2). Receiver operating curve (ROC) analysis indicated that NT-proBNP was the best predictor [area under the curve (AUC) 0.84; 95%CI: 0.76-0.92; P < 0.0001] with a negative predictive value of 100% (95% CI: 91-100) at 300 pg/ml. At that cut-off, the true negative rate for NT-proBNP was 40%. In multivariate analysis, NT-proBNP was the only significant independent predictors.

CONCLUSIONS

NT-proBNP appears to be a good risk stratification marker in identifying low-risk patients with non-massive PE who could be treated in an outpatient setting.

Authors+Show Affiliations

Division of Laboratory Medicine, Department of Genetics and Laboratory Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland. nicolas.vuilleumier@hcuge.chNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19087222

Citation

Vuilleumier, N, et al. "Cardiac Biomarkers for Risk Stratification in Non-massive Pulmonary Embolism: a Multicenter Prospective Study." Journal of Thrombosis and Haemostasis : JTH, vol. 7, no. 3, 2009, pp. 391-8.
Vuilleumier N, Le Gal G, Verschuren F, et al. Cardiac biomarkers for risk stratification in non-massive pulmonary embolism: a multicenter prospective study. J Thromb Haemost. 2009;7(3):391-8.
Vuilleumier, N., Le Gal, G., Verschuren, F., Perrier, A., Bounameaux, H., Turck, N., Sanchez, J. C., Mensi, N., Perneger, T., Hochstrasser, D., & Righini, M. (2009). Cardiac biomarkers for risk stratification in non-massive pulmonary embolism: a multicenter prospective study. Journal of Thrombosis and Haemostasis : JTH, 7(3), 391-8. https://doi.org/10.1111/j.1538-7836.2008.03260.x
Vuilleumier N, et al. Cardiac Biomarkers for Risk Stratification in Non-massive Pulmonary Embolism: a Multicenter Prospective Study. J Thromb Haemost. 2009;7(3):391-8. PubMed PMID: 19087222.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cardiac biomarkers for risk stratification in non-massive pulmonary embolism: a multicenter prospective study. AU - Vuilleumier,N, AU - Le Gal,G, AU - Verschuren,F, AU - Perrier,A, AU - Bounameaux,H, AU - Turck,N, AU - Sanchez,J-C, AU - Mensi,N, AU - Perneger,T, AU - Hochstrasser,D, AU - Righini,M, PY - 2008/12/18/entrez PY - 2008/12/18/pubmed PY - 2009/4/30/medline SP - 391 EP - 8 JF - Journal of thrombosis and haemostasis : JTH JO - J Thromb Haemost VL - 7 IS - 3 N2 - BACKGROUND: Troponins (cTnI and cTnT), N-terminal pro-Brain Natriuretic Peptide (NT-proBNP), myoglobin, heart-type fatty acid-binding protein (H-FABP) and fibrin D-Dimer are emergent candidates for risk stratification in pulmonary embolism (PE). OBJECTIVE: To compare the respective prognostic values of biomarker with non-massive PE to predict an adverse outcome at 3 months. PATIENTS/METHODS: One hundred and forty-six consecutive patients with non-massive PE were included in this multicenter prospective study. The combined outcome consisted of intensive care monitoring on admission, death or hospitalization attributable to either a PE-related complication [defined by PE/deep vein thrombosis (DVT) relapse or major bleeding under anticoagulation] or to dyspnoea with or without chest pain during follow-up. RESULTS: The outcome was met in 12% of patients. In univariate analysis, a NT-proBNP level above 300 pg/ml was the strongest predictor of unfavorable outcome with an odds ratio (OR) of 15.8 [95% confidence interval (CI): 2.05-122). ORs for the other variables were: 8.0 for D-dimer >2000 ng/ml (95% CI: 1.1-64), 4.7 for H-FABP >6 ng/ml (95% CI:1.5-14.8), 3.5 for cTnI >0.09 ng/ml (95% CI:1.2-9.7), 3.4 for myoglobin >70 ng/ml (95% CI:0.9-12.2). Receiver operating curve (ROC) analysis indicated that NT-proBNP was the best predictor [area under the curve (AUC) 0.84; 95%CI: 0.76-0.92; P < 0.0001] with a negative predictive value of 100% (95% CI: 91-100) at 300 pg/ml. At that cut-off, the true negative rate for NT-proBNP was 40%. In multivariate analysis, NT-proBNP was the only significant independent predictors. CONCLUSIONS: NT-proBNP appears to be a good risk stratification marker in identifying low-risk patients with non-massive PE who could be treated in an outpatient setting. SN - 1538-7836 UR - https://www.unboundmedicine.com/medline/citation/19087222/Cardiac_biomarkers_for_risk_stratification_in_non_massive_pulmonary_embolism:_a_multicenter_prospective_study_ L2 - https://doi.org/10.1111/j.1538-7836.2008.03260.x DB - PRIME DP - Unbound Medicine ER -