J Korean Soc Emerg Med.  2008 Feb;19(1):58-64.

Comparison of B-type Natriuretic Peptide and Troponin I for Diagnosis of Right Ventricular Dysfunction in Normotensive Pulmonary Embolism

• Kim WJ
• Yoon JC
• Oh BJ
• Kim W
• Lim KS

Abstract

PURPOSE: The severity of pulmonary embolism (PE) is determined by its associated degree of right ventricular dysfunction (RVD). In normotensive PE, the presence of RVD makes the prognosis worse and generally leads to consideration of fibrinolysis treatment. Routine usage of echocardiograhy in the diagnosis of RVD associated with PE is limited in the emergency department (ED). We evaluated the usefulness of B-type natriuretic peptide (BNP) and troponin I (TnI) levels for the diagnosis of right ventricular dysfunction in patients with normotensive PE and we suggest a cutoff value.
METHODS
Forty-five patients who visited the ED of Asan Medical Center from January 2003 to December 2006 and were confirmed with PE were retrospectively recruited. We excluded patients with heart failure or chronic renal failure. The cut-off values of BNP and TnI for diagnosis of RVD in normotensive PE were determined by receiver operating characteristic curve (ROC) analysis.
RESULTS
The cut-off value of BNP and TnI for the diagnosis of RVD were 149 pg/ml and 0.2 ng/ml, respectively, and the area under the ROC curve were 0.87(95% CI, 0.70-0.96) and 0.85(0.68~0.95). There were no significant differences in diagnostic accuracy between BNP and TnI (p=0.841).
CONCLUSION
In patients with normotensive PE, BNP and TnI were useful diagnostic test of RVD. The significant difference in diagnostic accuracy between BNP and TnI was not found. When BNP or TnI is elevated in normotensive PE patients, physician should consider RVD and suggest further evaluations.

Keyword

Pulmonary embolism; B-type natriuretic peptide; Troponin I; Ventricular Dysfunction; Right

MeSH Terms

Diagnostic Tests, Routine
Emergencies
Fibrinolysis
Heart Failure
Humans
Kidney Failure, Chronic
Natriuretic Peptide, Brain
Prognosis
Pulmonary Embolism
Retrospective Studies
ROC Curve
Troponin
Troponin I
Ventricular Dysfunction
Ventricular Dysfunction, Right
Natriuretic Peptide, Brain
Troponin
Troponin I