Prognostička vrijednost ehokardiografije i plazmatskih razina srčanih biljega u bolesnika s akutnom plućnom embolijom

Right ventricular dysfunction is central hemodynamic event in acute pulmonary embolism, and represents independent prognostic factor of adverse event. According to recent studies, echocardiography and cardiac biomarkers (cardiac troponins and natriuretic peptides) are useful tools in asessment of right ventricular dysfunction. The aim of study was to evaluate prognostic value of echocardiography and cardiac biomarkers associated with early adverse outcome of APE patients. This was a single-center prospective study of APE patients conducted from September 2006 to November 2008 at Intensive Care Unit in University Hospital Sisters of Mercy in Zagreb, Croatia. The study population included 104 patients. The diagnosis of APE was confirmed in all patients using spiral computed tomography. Patients were, according to European society of cardiology guidelines, divided into three severity groups: high-risk (n=33; 31.7%), intermediate-risk (n=51; 49.1%) and low-risk (n=20; 19.2%). BNP, NT- proBNP and (cTnT) were measured at admission and 6, 12, 24 and 72 hours after addmition. Echocardiography was performed within 24 hours after admission. Main outcome measure was in-hospital death. Among 104 patients 19 (18,7%) died, none of whom was in low risk group (p 500pg/ml could detect patients with persitent right ventricular dysfunction 48 hours after admission in Intensive Care Unit and therefore could provide additional information regarding risk stratification. Among all investigated paramteters, only BNP showed correlation with disease outcome. Initial BNP concentrations above 526 pg/ml showed excellent negative predictive value od 100%. We can conclude that echocardiography and increased levels of cTnT and NT-proBNP successfully detect haemodinamically stable APE patients with right ventricular dysfunction, while initially increased levels of BNP detect patients with higher risk of death. Serial sampling of NT-proBNP, up to 48 hours, can be used in detecting patients with persistent right ventricular dysfunction and therefore could provide additional information in further risk stratification.