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Helical computerized tomography and NT-proBNP for screening of right ventricular overload on admission and at long term follow-up of acute pulmonary embolism
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 05/07/2012
Laiho MK et al. – Transthoracic echocardiography (TTE) does not confer further benefit when helical computerized tomography (CT) is used for screening for right ventricular dysfunction (RVD) in nonhigh risk acute pulmonary embolism (APE). All the patients who were found to have RVD in TTE at seven months followup had had RVD in the acute phase CT as well. Thus, patients without RVD in diagnostic CT do 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–proBNP at follow–up. A follow–up protocol based on these findings is suggested.
Methods- Sixty-three non-high risk APE patients were studied.
- RVD was assessed at admission in the emergency 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 were similar in CT and TTE (p<0.0001).
- NT-proBNP was elevated ([greater than or equal to] 350ng/l) in 32 (86 %) patients with RVD but in only seven (27 %) patients without RVD (p<0.0001).
- All the patients 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 in the follow-up compared with 5 (9%) of patients without RVD (p<0.0001).