SESSION TITLE: Diagnosis and Evaluation of Venous Thromboembolism SESSION TYPE: Original Investigation Slide PRESENTED ON: Wednesday, November 1, 2017 at 08:45 AM - 10:00 AM PURPOSE: Elevated Brain Natriuretic Peptide (BNP) and Troponin I (TnI) have been shown to have good predictive value for poor outcomes in pulmonary embolism. An increased BNP/TnI ratio (BTR) has been shown to be predictive of Takotsubo’s Cardiomyopathy and a decreased ratio is predictive of cardiac ischemia as an etiology for chest pain in patients admitted to an ER. The role of BTR in acute pulmonary embolism (PE) remains undefined. The aim of this study was to determine if an increased BTR was associated with a worse prognosis in acute PE. METHODS: All patients who were diagnosed with pulmonary embolism in an urban, teaching hospital were enrolled in a prospective registry. We retrospectively evaluated the clinical characteristics, echocardiographic abnormalities, BNP, TnI, BTR and survival rates in consecutive patients. RESULTS: In 263 patients, mean age 58 years, we found that BTR was higher in patients with RV dilation (7,373 vs 5,034, p=0.996) and with RV hypokinesis (7,070 vs 5,153, p=0.896) on echocardiogram. A lower BTR was found in patients who survived to discharge (5,286 vs 11,535, p=0.450), 30 days (5,587 vs 8,949, p=0.263, n=222) and 90 days (5,590 vs 9,620, p=0.049, n=116). The BTR was higher in patients who were admitted to ICU (8,069 vs 5,078, p=0.546) than those admitted to a hospital floor. The BTR was lower (3,378 vs 5,686, p=0.029) in patients with a central PE, defined as saddle or main pulmonary artery. CONCLUSIONS: We conclude that an elevated BTR can be a useful diagnostic tool and that it may predict an increased 90 day mortality following an acute PE. The statistically significant decrease in BTR in patients with a central PE could be secondary to less RV dilation, and/or more myocardial necrosis. CLINICAL IMPLICATIONS: While BNP and TnI have both been used independently to risk stratify patients with an acute pulmonary embolism, their relative role has not been clearly defined. BTR adds to our knowledge in this field and suggests elevation in BNP out of proportion to elevation in TnI may portend a worse outcome. DISCLOSURE: The following authors have nothing to disclose: Eric Bondarsky, Matthew Schaikewitz, Jason Filopei, David Steiger No Product/Research Disclosure Information