What study discusses the risk-stratification strategy using N-terminal prohormone of brain natriuretic peptide (NT-proBNP) in patients with right ventricular (RV) dysfunction and pulmonary disease?

Updated: Jan 08, 2018
  • Author: Donald Schreiber, MD, CM; Chief Editor: Erik D Schraga, MD  more...
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The same group went on to develop a risk-stratification strategy using NT-proBNP. [70] In their validation study, both echocardiograms and NT-proBNP levels were recorded in 100 consecutive patients with acute PE. An NT-proBNP level of less than 600pg/mL was predictive of a benign course, with a mortality rate of only 4%, compared with a 33% mortality rate for patients with levels greater than 600pg/mL.

Of interest, on multivariate analysis, echocardiographic results were not independent predictors of adverse events, but NT-proBNP levels were. However, this effect may simply have been due to small sample size.

Another group examined 124 consecutive patients with proven PE who also underwent echocardiography to detect RV dysfunction and baseline measurement of NT-proBNP values. [71] Results were compared with the endpoint of death or major in-hospital adverse events. A baseline NT-proBNP cutoff of less than 1000 pg/mL had NPVs of 95% for a complicated course and 100% for death. However, an NT-proBNP level higher than this had little predictive power.

An echocardiogram demonstrating RV dysfunction was associated with a 12-fold elevation in the complication risk, whereas NT-proBNP elevation without RV dysfunction on echocardiography did not significantly increase the risk of an adverse outcome. The authors proposed NT-proBNP assay as an initial screening test in acute PE, with echocardiography reserved for patients with elevated NT-proBNP levels.

The utility of BNP and NT-proBNP testing in identifying low-risk patients with acute PE who may be eligible for outpatient therapy requires further evaluation in large studies. Furthermore, the use of the natriuretic peptides in patients with RV failure associated with other pulmonary disorders, such as obstructive sleep apnea, pulmonary hypertension, and severe chronic obstructive pulmonary disease, with cor pulmonale also requires further study.

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