Simultaneous measurement of serum cTnT and NT-proBNP allows for precise APE prognosis. Normotensive patients on admission with cTnT> or =0.07 microg/L and NT-proBNP> or =600 ng/L are at high risk of APE mortality, whereas NTproBNP<600 ng/L indicates excellent prognosis.

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Plasma brain natriuretic peptide (BNP), released from myocytes of ventricles upon stretch, has been reported to differentiate pulmonary from cardiac dyspnoea. Limited data have shown elevated plasma BNP levels in acute pulmonary embolism (APE), frequently accompanied by dyspnoea and right ventricular (RV) dysfunction. The aim of this study was to assess plasma N-terminal proBNP (NTproBNP) in APE, and to establish whether it reflects the severity of RV overload and if it can be used to predict adverse clinical outcome.On admission, NT-proBNP and echocardiography for RV overload were performed in 79 APE patients (29 males), aged 63¡16 yrs.Plasma NT-proBNP was elevated in 66 patients (83.5%) and was higher in patients with (median 4,650 pg?mL -1 (range 61-60,958)) than without RV strain (363 pg?mL -1 329)). RV-to-left ventricular ratio and inferior vena cava dimension correlated with NT-proBNP. All 15 in-hospital deaths and 24 serious adverse events occurred in the group with elevated NT-proBNP, while all 13 (16.5%) patients with normal values had an uncomplicated clinical course. Plasma NT-proBNP predicted in-hospital mortality. Plasma N-terminal pro-brain natriuretic peptide is elevated in the majority of cases of pulmonary embolism resulting in right ventricular overload. Plasma levels reflect the degree of right ventricular overload and may help to predict short-term outcome. Acute pulmonary embolism should be considered in the differential diagnosis of patients with dyspnoea and abnormal levels of brain natriuretic peptide. Eur Respir J 2003; 22: 649-653. Elevated plasma levels of brain natriuretic peptide (BNP) released from myocytes of ventricles upon stretch have been found in patients with congestive heart failure and even in those with asymptomatic left ventricular (LV) systolic dysfunction [1,2]. Moreover, elevated plasma BNP was found in patients with primary pulmonary hypertension and chronic thromboembolic pulmonary hypertension [3,4]. Interestingly, elevated plasma BNP was reported to help differentiate pulmonary from cardiac aetiologies of acute dyspnoea [5]. Plasma N-terminal proBNP (NT-proBNP) is also increased in congestive heart failure patients [6] and it may help to stratify their prognosis [7,8]. However, limited data suggest that plasma BNP may be elevated in patients with acute pulmonary embolism (APE), frequently accompanied by acute dyspnoea and right ventricular (RV) dysfunction [9][10][11]. Therefore, the aim of this study was to assess plasma levels of NT-proBNP in patients with APE, and to establish whether the levels reflect the severity of RV overload and whether they can be used to predict adverse clinical outcome. Materials and methods Clinical dataThe study analysed consecutive patients with symptomatic APE. APE was confirmed by contrast-enhanced spiral computed tomography or by high-probability lung scintigraphy according to PIOPED (Prospective Investigation of Pulmonary Embolism Diagnosis) criteria [12]. On admission, systemic blood pressure (BP) and cardiac frequency...

Our aim was the assessment of the prognostic significance of right heart thrombi (RiHT) and their characteristics in pulmonary embolism in relation to established prognostic factors.138 patients (69 females) aged (mean±SD) 62±19 years with RiHT were included into a multicenter registry. A control group of 276 patients without RiHT was created by propensity scoring from a cohort of 963 contemporary patients. The primary end-point was 30-day pulmonary embolism-related mortality; the secondary end-point included 30-day all-cause mortality. In RiHT patients, pulmonary embolism mortality was higher in 31 patients with systolic blood pressure <90 mmHg than in 107 normotensives (42% versus 12%, p=0.0002) and was higher in the 83 normotensives with right ventricular dysfunction (RVD) than in the 24 normotensives without RVD (16% versus 0%, p=0.038). In multivariable analysis the simplified Pulmonary Embolism Severity Index predicted mortality (hazard ratio 2.43, 95% CI 1.58-3.73; p<0.0001), while RiHT characteristics did not. Patients with RiHT had higher pulmonary embolism mortality than controls (19% versus 8%, p=0.003), especially normotensive patients with RVD (16% versus 7%, p=0.02).30-day mortality in patients with RiHT is related to haemodynamic consequences of pulmonary embolism and not to RiHT characteristics. However, patients with RiHT and pulmonary embolism resulting in RVD seem to have worse prognosis than propensity score-matched controls. @ERSpublications Prognosis in patients with PE and RiHT is related to haemodynamic effects of PE, not RiHT morphology

Proximal pulmonary emboli modify right ventricular ejection pattern. A. Torbicki, M. Kurzyna, M. Ciurzynski, P. Pruszczyk, R. Pacho, A. Kuch-Wocial, M. Szulc. #ERS Journals Ltd 1999. ABSTRACT: Analysis of the systolic flow velocity curve (SFVC) in the right ventricular outflow tract is considered as an alternative to the tricuspid valve pressure gradient (TVPG) method for echo-Doppler assessment of pulmonary arterial pressure (Ppa). The present study checked whether or not SFVC is affected by the cause of pulmonary hypertension.Doppler recordings of 86 patients (39 female, aged 55.515.2 yrs) with acute (AP-PE) or chronic (CP-PE) proximal pulmonary embolism, chronic obstructive pulmonary disase (COPD) or primary pulmonary hypertension (PPH) were retrospectively analysed by two observers unaware of the purpose of the study.Despite having the lowest TVPG (4813 mmHg), patients with AP-PE had the shortest acceleration time (tacc; 5615 ms) and time to midsystolic deceleration (tmsd; 10516 ms). tacc <60 ms in patients with TVPG <60 mmHg had 98% specificity and 48% sensitivity for AP-PE. In PPH, SFVC was less abnormal (tacc 6414 ms, tmsd 12525 ms, both p<0.03) despite having a TVPG twice as high (9212 mmHg, p< 0.001). In contrast to tacc, TVPG showed strong correlation with direct Ppa measurements whenever performed (r=-0.43, p=0.02, versus r=0.80, p<0.001; n=30). There was no correlation between tacc and TVPG in a pooled study group and SFVC seemed strongly affected by the presence of both AP-PE and CP-PE.While potentially useful for evaluation of the true right ventricular afterload during pulsatile flow conditions, the systolic flow velocity curve does not provide a reliable estimate of pulmonary arterial pressure. Eur Respir J 1999; 13: 616±621. The method of choice for noninvasive estimation of pulmonary arterial pressure (Ppa) is based on continuous wave Doppler measurement of the peak velocity of the regurgitant jet across the tricuspid valve (tricuspid valve pressure gradient; TVPG). This method, based on the simplified Bernoulli equation and a straightforward pathophysiological concept, proved highly reliable in a wide spectrum of cardiovascular disease [1±4].However, the pulsed wave Doppler-derived pattern of the systolic flow velocity curve (SFVC) in the right ventricular (RV) outflow tract is also believed to reflect the level of Ppa [5±9]. Using SFVC is appealing because, in contrast to TVPG, it can be recorded in almost every patient, including those with lung hyperinflation [10]. Coexistence of short acceleration time (tacc) and midsystolic deceleration (tmsd; which has a "notched" pattern) is considered diagnostic of severe pulmonary hypertension [5]. However, such patterns have also been observed in the setting of acute pulmonary embolism [11] and similar changes have been induced experimentally by proximal constriction of the proximal pulmonary arteries in dogs [12]. In both these situations, marked SFVC changes were found in the presence of acute but relatively mild elevation of Ppa limited by the per...