Scientific article

Cardiac biomarkers for risk stratification in non-massive pulmonary embolism: a multicenter prospective study

Published inJournal of thrombosis and haemostasis, vol. 7, no. 3, p. 391-398
Publication date2009

BACKGROUND: Troponins (cTnI and cTnT), N-terminal pro-Brain Natriuretic Peptide (NT-proBNP), myoglobin, heart-type fatty acid-binding protein (H-FABP) and fibrin D-Dimer are emergent candidates for risk stratification in pulmonary embolism (PE). OBJECTIVE: To compare the respective prognostic values of biomarker with non-massive PE to predict an adverse outcome at 3 months. PATIENTS/METHODS: One hundred and forty-six consecutive patients with non-massive PE were included in this multicenter prospective study. The combined outcome consisted of intensive care monitoring on admission, death or hospitalization attributable to either a PE-related complication [defined by PE/deep vein thrombosis (DVT) relapse or major bleeding under anticoagulation] or to dyspnoea with or without chest pain during follow-up. RESULTS: The outcome was met in 12% of patients. In univariate analysis, a NT-proBNP level above 300 pg/ml was the strongest predictor of unfavorable outcome with an odds ratio (OR) of 15.8 [95% confidence interval (CI): 2.05-122). ORs for the other variables were: 8.0 for D-dimer >2000 ng/ml (95% CI: 1.1-64), 4.7 for H-FABP >6 ng/ml (95% CI:1.5-14.8), 3.5 for cTnI >0.09 ng/ml (95% CI:1.2-9.7), 3.4 for myoglobin >70 ng/ml (95% CI:0.9-12.2). Receiver operating curve (ROC) analysis indicated that NT-proBNP was the best predictor [area under the curve (AUC) 0.84; 95%CI: 0.76-0.92; P < 0.0001] with a negative predictive value of 100% (95% CI: 91-100) at 300 pg/ml. At that cut-off, the true negative rate for NT-proBNP was 40%. In multivariate analysis, NT-proBNP was the only significant independent predictors. CONCLUSIONS: NT-proBNP appears to be a good risk stratification marker in identifying low-risk patients with non-massive PE who could be treated in an outpatient setting.

  • Adolescent
  • Adult
  • Biological Markers
  • Fatty Acid-Binding Proteins/blood
  • Female
  • Fibrin Fibrinogen Degradation Products/analysis
  • Humans
  • Middle Aged
  • Natriuretic Peptide, Brain/blood
  • Odds Ratio
  • Peptide Fragments/blood
  • *Predictive Value of Tests
  • Prognosis
  • Prospective Studies
  • Pulmonary Embolism/*diagnosis
  • Risk Assessment
  • Troponin/blood
  • Young Adult
Citation (ISO format)
VUILLEUMIER, Nicolas et al. Cardiac biomarkers for risk stratification in non-massive pulmonary embolism: a multicenter prospective study. In: Journal of thrombosis and haemostasis, 2009, vol. 7, n° 3, p. 391–398. doi: 10.1111/j.1538-7836.2008.03260.x
Main files (1)
ISSN of the journal1538-7836

Technical informations

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