Helical computerized tomography and NT-proBNP for screening of right ventricular overload on admission and at long term follow-up of acute pulmonary embolism
Right ventricular dysfunction (RVD) in acute pulmonary embolism (APE) can be assessedwith 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 initialdiagnostic strategy and the use of NT-proBNP and TnT for screening for long-termprobability of RVD remains unknown.The aim of the study was to determine the role of helical CT and NT-proBNP in detection ofRVD in the acute phase.
In addition, the value of NT-proBNP for ruling out RVD at longtermfollow-up was assessed.
Sixty-three non-high risk APE patients were studied. RVD was assessed at admission in theemergency department by CT and TTE, and both NT-proBNP and TnT samples were taken.These, excepting CT, were repeated seven months later.
At admission RVD was detected by CT in 37 (59 %) patients.
RVD findings in CT weresimilar in CT and TTE (p <0.0001). NT-proBNP was elevated ([greater than or equal to] 350 ng/l) in 32 (86 %)patients with RVD but in only seven (27 %) patients without RVD (p <0.0001).
All thepatients 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 inthe follow-up compared with 5 (9%) of patients without RVD (p <0.0001).
TTE does not confer further benefit when helical CT is used for screening for RVD in nonhighrisk APE. All the patients who were found to have RVD in TTE at seven months followuphad had RVD in the acute phase CT as well.
Thus, patients without RVD in diagnostic CTdo 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-proBNPat follow-up.
A follow-up protocol based on these findings is suggested.
Author: Mia K LaihoVeli-Pekka HarjolaMarit GranerAnneli PiilonenMerja RaadePirjo Mustonen Credits/Source: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2012, 20:33
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