Pulmonary embolism biomarkers
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Editor(s)-In-Chief: The APEX Trial Investigators, C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Overview
The assessment of brain natriuretic peptide levels to diagnose PE has limited use because of the reduced sensitivity. However, elevated BNP and pro-BNP levels accurately predict right ventricular dysfunction and associated mortality; hence, may used as a prognostic marker.
Brain natriuretic peptide (BNP)
Although, elevated BNP levels have been demonstrated in pulmonary embolism patients with ventilation-perfusion mismatch,[1] the associated usefulness of routinely assessing BNP levels to diagnose PE is not indicated as it is non-specific and has reduced sensitivity secondary to the presence of other etiologies which falsely elevate BNP levels in acute case scenarios.[2]
In 2006, Sohne et al, demonstrated that the presence of elevated BNP levels at admission was associated with early (fatal) recurrent venous thromboembolism in hemodynamically stable patients with acute PE. However, this relationship appeared to be clinically insignificant when used as a guide to initiate early thrombolysis in this population. Furthermore, the sensitivity and specificity of assessing BNP levels as a diagnostic test was found to be 60% and 62%, respectively.[2]
On the contrary, the benefit of using elevated BNP and pro-BNP levels as a prognostic marker[3] may be derived from the results of three meta-analysis[4][5][6] which demonstrated that elevated BNP levels accurately predicted right ventricular dysfunction and associated mortality.[5]
Troponin
Serum troponin I and troponin T are elevated in approximately thirty to fifty percent of the PE patients.[7][8] The suspected mechanism is due to acute right heart overload.[9] Troponin elevation is more prolonged in acute MI rather in PE and usually resolve within 40 hours after a PE event.[10] Thus troponins are not useful for diagnosis, but there role in prognostic assessment has been proved in a meta-analysis.[11]
References
- ↑ Kiely DG, Kennedy NS, Pirzada O, Batchelor SA, Struthers AD, Lipworth BJ (2005). "Elevated levels of natriuretic peptides in patients with pulmonary thromboembolism". Respiratory Medicine. 99 (10): 1286–91. doi:10.1016/j.rmed.2005.02.029. PMID 16099151. Retrieved 2012-05-01. Unknown parameter
|month=ignored (help) - ↑ 2.0 2.1 Söhne M, Ten Wolde M, Boomsma F, Reitsma JB, Douketis JD, Büller HR (2006). "Brain natriuretic peptide in hemodynamically stable acute pulmonary embolism". Journal of Thrombosis and Haemostasis : JTH. 4 (3): 552–6. doi:10.1111/j.1538-7836.2005.01752.x. PMID 16405522. Retrieved 2012-05-01. Unknown parameter
|month=ignored (help) - ↑ Agnelli G, Becattini C (2010). "Acute pulmonary embolism". The New England Journal of Medicine. 363 (3): 266–74. doi:10.1056/NEJMra0907731. PMID 20592294. Retrieved 2012-05-01. Unknown parameter
|month=ignored (help) - ↑ Cavallazzi R, Nair A, Vasu T, Marik PE (2008). "Natriuretic peptides in acute pulmonary embolism: a systematic review". Intensive Care Medicine. 34 (12): 2147–56. doi:10.1007/s00134-008-1214-5. PMID 18626627. Retrieved 2012-05-01. Unknown parameter
|month=ignored (help) - ↑ 5.0 5.1 Klok FA, Mos IC, Huisman MV (2008). "Brain-type natriuretic peptide levels in the prediction of adverse outcome in patients with pulmonary embolism: a systematic review and meta-analysis". American Journal of Respiratory and Critical Care Medicine. 178 (4): 425–30. doi:10.1164/rccm.200803-459OC. PMID 18556626. Retrieved 2012-05-01. Unknown parameter
|month=ignored (help) - ↑ Lega JC, Lacasse Y, Lakhal L, Provencher S (2009). "Natriuretic peptides and troponins in pulmonary embolism: a meta-analysis". Thorax. 64 (10): 869–75. doi:10.1136/thx.2008.110965. PMID 19525265. Retrieved 2012-05-01. Unknown parameter
|month=ignored (help) - ↑ Horlander KT, Leeper KV (2003). "Troponin levels as a guide to treatment of pulmonary embolism". Curr Opin Pulm Med. 9 (5): 374–7. PMID 12904706.
- ↑ Konstantinides S, Geibel A, Olschewski M, Kasper W, Hruska N, Jäckle S; et al. (2002). "Importance of cardiac troponins I and T in risk stratification of patients with acute pulmonary embolism". Circulation. 106 (10): 1263–8. PMID 12208803.
- ↑ Meyer T, Binder L, Hruska N, Luthe H, Buchwald AB (2000). "Cardiac troponin I elevation in acute pulmonary embolism is associated with right ventricular dysfunction". J Am Coll Cardiol. 36 (5): 1632–6. PMID 11079669.
- ↑ Müller-Bardorff M, Weidtmann B, Giannitsis E, Kurowski V, Katus HA (2002). "Release kinetics of cardiac troponin T in survivors of confirmed severe pulmonary embolism". Clin Chem. 48 (4): 673–5. PMID 11901075.
- ↑ Jiménez D, Díaz G, Molina J, Martí D, Del Rey J, García-Rull S; et al. (2008). "Troponin I and risk stratification of patients with acute nonmassive pulmonary embolism". Eur Respir J. 31 (4): 847–53. doi:10.1183/09031936.00113307. PMID 18094010.