Title1 Brain Natriuretic Peptide Levels Have A Significant Prognostic Role In Patients With...
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Transcript of Title1 Brain Natriuretic Peptide Levels Have A Significant Prognostic Role In Patients With...
Title 1
Brain Natriuretic Peptide Levels Have A
Significant Prognostic Role In Patients With
Suspected Or Confirmed Acute Pulmonary
Embolism: Evidence From A Meta-Analysis
Marzia Lotrionte (a), Giuseppe Biondi Zoccai (b), Claudio
Moretti (b), Pierluigi Omedè (b), Filippo Sciuto (b),
Giuseppe Sangiorgi (b), Antonio Abbate (b), Gian Paolo
Trevi (b), Imad Sheiban (b)
(a)Catholic University, Rome, Italy ([email protected]);
(b) University of Turin, Turin, Italy
Title>Background 2
BACKGROUND• Acute pulmonary embolism (PE) is a common
disease with a highly variable impact on morbidity and mortality.
• Despite promising data on computed tomography, echocardiography and serum troponin, prognostication is still suboptimal.
• Brain natriuretic peptides (BNP) have an established prognostic role in several cardiopulmonary conditions, yet their predictive role in acute pulmonary embolism is still debated.
Title>Background>Aim 3
AIM OF OUR WORK
• We aimed to perform a comprehensive meta-analysis of studies appraising the prognostic role of BNP in patients with acute pulmonary embolism.
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METHODS• Pertinent studies employing either BNP or NT-pro-BNP
assays for risk prognostication in subjects with suspected or confirmed acute pulmonary embolism were searched in several databases (May 2008).
• Study design features, patient characteristics, assay details and outcomes were abstracted.
• Specifically, the end-points of interest were in-hospital rates of death and in-hospital rates of major adverse cardiopulmonary events (MACPE, defined as death, or need for cardiopulmonary resuscitation, mechanical ventilation, vasopressors, thrombolysis, surgical or percutaneous intervention, or intensive care unit admission).
Title>Background>Aim>Methods 4
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METHODS• Both unadjusted and multivariable adjusted
relative risks (RR) were computed with 95% confidence intervals by means of fixed-effect method, yielding p values for statistical significance (set at the 2-tailed 0.05 level) and statistical heterogeneity (set at the 2-tailed 0.10 level).
• Prognostic discrimination was also appraised as c-statistics with summary receiver-operating curves.
Title>Background>Aim>Methods 5
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RESULTS• A total of 14 studies were included, enrolling a
total of 1,088 patients.• The median cut-off to define an abnormal BNP
level was 487 pg/mL (range 25%-75%: 90-600).• The risk of in-hospital death was significantly
higher among patients with high BNP levels (83/456 [18.2%]) than in subjects with low BNP levels (15/581 [2.6%], RR=7.1 [4.1-12.2], p<0.00001).
Title>Background>Aim>Methods>Results 6
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RESULTS• Similarly, patients with high BNP levels had a significantly
higher in-hospital rate of MACPE in comparison to those with low BNP levels (163/458 [35.6%] vs 23/464 [5.0%], RR=7.8 [5.0-12.0], p<0.00001).
• Even after multivariable adjustment, high BNP levels were associated with a significantly increased risk for death (RR=2.5 [1.6-4.0], p<0.0001) and MACPE (RR=2.2 [1.5-3.2], p<0.0001).
• Finally, BNP levels disclosed a satisfactory prognostic discrimination with c-statistic values of 0.83 (0.77-0.89) for death and of 0.80 (0.72-0.88) for MACPE.
Title>Background>Aim>Methods>Results 7
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CONCLUSIONS• Serum levels of brain natriuretic peptides have a
significant and independent prognostic role in patients with suspected or confirmed acute pulmonary embolism.
• These findings have major clinical implications, and demonstrate that brain natriuretic peptide levels should be measured whenever acute pulmonary embolism is suspected to more precisely risk-stratify such patients.
Title>Background>Aim>Methods>Results>Conclusions 12
Thank you for your attention
For any correspondence:[email protected]
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