정상혈압을 가진 폐색전증 환자에서 우심실 기능부전의 진단을 위한 B-typenatriuretic peptide와 Troponin I의 유용성 비교 = Comparison of B-type NatriureticPeptide and Troponin I for Diagnosisof Right Ventricular Dysfunction inNormotensive Pulmonary Embolism

다국어 초록 (Multilingual 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.

참고문헌 (Reference)

1 Pieralli F, "Usefulness of bedside testing for brain natriuretic peptide to identify right ventricular dysfunction and outcome in normotensive patients with acute pulmonary embolism" 97 : 1386-1390, 2006

2 Kreit JW, "The impact of right ventricular dysfunction on the prognosis and therapy of normotensive patients with pulmonary embolism" 125 : 1539-1545, 2004

3 Grifoni S, "Short-term clinical outcome of patients with acute pulmonary embolism, normal blood pressure, and echocardiographic right ventricular dysfunction" 101 : 2817-2122, 2000

4 Punukollu G, "Role of electrocardiography in identifying right ventricular dysfunction in acute pulmonary embolism" 96 : 450-452, 2005

5 Lualdi JC, "Right ventricular dysfunction after acute pulmonary embolism: pathophysiologic factors, detection, and therapeutic implications" 130 : 1276-1282, 1995

6 Maisel AS, "Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure" 347 : 161-167, 2002

7 Konstantinides S, "Pulmonary embolism: impact of right ventricular dysfunction" 20 : 496-501, 2005

8 Khan NU, "Pulmonary embolism and cardiac enzymes" 34 : 142-146, 2005

9 ten Wolde M, "Prognostic value of echocardiographically assessed right ventricular dysfunction in patients with pulmonary embolism" 164 : 1685-1689, 2004

10 Nagaya N, "Plasma brain natriuretic peptide levels increase in proportion to the extent of right ventricular dysfunction in pulmonary hypertension" 31 : 202-208, 1998

11 Tulevski II, "Increased brain natriuretic peptide as a marker for right ventricular dysfunction in acute pulmonary embolism" 86 : 1193-1196, 2001

12 Tulevski II, "Increased brain and atrial natriuretic peptides in patients with chronic right ventricular pressure overload: correlation between plasma neurohormones and right ventricular dysfunction" 86 : 27-30, 2001

13 Douketis JD, "Elevated cardiac troponin levels in patients with submassive pulmonary embolism" 162 : 79-81, 2002

14 Antman EM, "Decision making with cardiac troponin tests" 346 : 2079-2082, 2002

15 Punukollu G, "Cardiac troponin I release in acute pulmonary embolism in relation to the duration of symptoms" 99 : 207-211, 2005

16 Meyer T, "Cardiac troponin I elevation in acute pulmonary embolism is associated with right ventricular dysfunction" 36 : 1632-1636, 2000

17 Kruger S, "Brain natriuretic peptide predicts right heart failure in patients with acute pulmonary embolism" 147 : 60-65, 2004

18 So¨hne M, "Biomarkers in pulmonary embolisms" 19 : 558-562, 2004

19 Logeart D, "Biomarker-based strategy for screening right ventricular dysfunction in patients with non-massive pulmonary embolism" 33 : 286-292, 2007