Utility of brain natriuretic peptide to predict right ventricular dysfunction and clinical outcome in patients with acute pulmonary embolism.

Abstract

To the Editor: We read the paper by Kucher et al,1 which demonstrated the association between high levels of pro-brain natriuretic peptide (BNP) and increased risk of adverse clinical outcome (death, resuscitation, mechanical ventilation, pressors, thrombolysis, catheter fragmentation, and surgical embolectomy) in patients with acute pulmonary embolism. The authors concluded that patients with acute pulmonary embolism and low pro-BNP levels have an uneventful course and good prognosis. We studied 50 patients with confirmed acute pulmonary embolism prospectively and followed them up for their in-hospital course and complications.2 Echocardiography and BNP measurement were performed in all patients at admission. Thirty-one patients (62%) of our study population had right ventricular (RV) dysfunction (dilatation of the right ventricle with a diastolic diameter >30 mm, RV/left ventricular end-diastolic diameter ratio >1, or hypokinesis of the right ventricle). We found that patients without RV dysfunction had significantly lower BNP levels compared with patients with RV dysfunction. There was a significant correlation between RV end-diastolic diameter and BNP. In addition, BNP discriminated between patients with and those without RV dysfunction (area under the receiver operating characteristic, 0.78). A BNP >90 pg/mL was associated with a …