The significance of B-type natriuretic peptide in predicting early mortality among pulmonary embolism patients, alongside troponin: insights from a multicentric registry

Dzudovic Boris; Simpson Tamara; Djuric Ivica; Subotic Bojana; Matijasevic Jovan; Dzudovic Jelena; Benic Marija; Salinger Sonja; Kos Ljiljana; Kovacevic-Preradovic Tamara; Mitevska Irena; Kafedzic Srdjan; Neskovic Aleksandar; Mitrovic Bojan; Bozovic Bjanka; Bulatovic Nebojsa; Miloradovic Vladimir; Obradovic Slobodan

doi:10.1016/j.cpcardiol.2024.102437

The significance of B-type natriuretic peptide in predicting early mortality among pulmonary embolism patients, alongside troponin: insights from a multicentric registry

Curr Probl Cardiol. 2024 Apr;49(4):102437. doi: 10.1016/j.cpcardiol.2024.102437. Epub 2024 Feb 1.

Authors

Dzudovic Boris¹, Simpson Tamara², Djuric Ivica³, Subotic Bojana³, Matijasevic Jovan⁴, Dzudovic Jelena⁵, Benic Marija⁶, Salinger Sonja⁷, Kos Ljiljana⁸, Kovacevic-Preradovic Tamara⁹, Mitevska Irena¹⁰, Kafedzic Srdjan¹¹, Neskovic Aleksandar¹², Mitrovic Bojan¹¹, Bozovic Bjanka¹³, Bulatovic Nebojsa¹³, Miloradovic Vladimir¹⁴, Obradovic Slobodan¹⁵

Affiliations

¹ Clinic of Emergency Internal Medicine, Military Medical Academy, Belgrade, Serbia; School of Medicine, University of Defense, Belgrade, Serbia. Electronic address: boris.dzudovic@vma.mod.gov.rs.
² Jacobi/North Central Bronx Hospital, New York, NY, USA.
³ Clinic of Cardiology, Military Medical Academy, Belgrade, Serbia.
⁴ Institute of Pulmonary Diseases Vojvodina, Novi Sad, Serbia; School of Medicine, University of Novi Sad, Serbia.
⁵ National Poison Control Center, Military Medical Academy, Belgrade, Serbia.
⁶ Institute of Pulmonary Diseases Vojvodina, Novi Sad, Serbia.
⁷ Clinic of Cardiology, Clinical Center Nis, Serbia; School of Medicine, University of Nis, Serbia.
⁸ Clinic of Cardiology, Clinical Center Banja Luka, Bosnia and Herzegovina.
⁹ Clinic of Cardiology, Clinical Center Banja Luka, Bosnia and Herzegovina; School of Medicine, University of Banja Luka, Bosnia and Herzegovina.
¹⁰ University Cardiology Clinic, Intensive Care Unit, Skopje, North Macedonia.
¹¹ Clinic of Cardiology, University Clinical Center Zemun, Serbia.
¹² Clinic of Cardiology, University Clinical Center Zemun, Serbia; School of Medicine, University of Belgrade, Serbia.
¹³ Clinic of Cardiology, Clinical Center Podgorica, Montenegro; School of Medicine, University of Podgorica, Montenegro.
¹⁴ Clinic of Cardiology, Clinical Center Kragujevac, Serbia,; School of Medicine, University of Kragujevac, Serbia.
¹⁵ School of Medicine, University of Defense, Belgrade, Serbia; Clinic of Cardiology, Military Medical Academy, Belgrade, Serbia.

PMID: 38309548
DOI: 10.1016/j.cpcardiol.2024.102437

Abstract

Background: Early mortality assessment in acute pulmonary embolism (PE) is crucial for treatment decisions. The role of natriuretic peptides in this context is debated. This study explores elevated B-type natriuretic peptide (BNP) levels, relative to the upper normal limit (UNL), predicting mortality in PE, comparing with troponin (Tn).

Methodology: A multicenter PE registry analyzed predictive values for early mortality risk using BNP and Tn, based on proportional elevation to the UNL. Patients followed current PE guidelines.

Results: Among 1677 PE patients, BNP's AUC exceeded Tn for all-cause (0.727 vs. 0.614) and PE-related mortality (0.785 vs. 0.644), though nonsignificant. BNP's cutoff was 3.5 times UNL for both all-cause and PE-related mortalities; Tn cutoffs were 1.38 and 1.23 times UNL, respectively.

Conclusion: Elevated BNP relative to UNL significantly predicts all-cause and PE-related mortality. While akin to Tn, BNP merits consideration in assessing acute PE risk, especially in intermediate-high-risk cases.

Keywords: Acute pulmonary embolism; B-type natriuretic peptide; Mortality; Risk assessment; Troponin.

Publication types

Multicenter Study

MeSH terms

Humans
Natriuretic Peptide, Brain*
Pulmonary Embolism* / diagnosis
Registries
Troponin
Vasodilator Agents

Substances

Natriuretic Peptide, Brain
Vasodilator Agents
Troponin