Predictive Power of N-terminal Prohormone of Brain Natriuretic Peptide on Admission and on Discharge for Short- and Long-term Clinical and Echocardiographic Outcomes in Patients With Pulmonary Thromboembolism

Background: This prospective case-series study was conducted to determine the predictive power of the N-terminal prohormone of brain natriuretic peptide (NT-proBNP) on shortand long-term outcomes in patients with pulmonary thromboembolism (PTE). Methods: Ninety-two patients (age = 60 ± 1.97 y, 54.7% male) diagnosed with PTE were recruited. NT-proBNP levels and echocardiographic indices were measured and recorded. The primary endpoint was considered to be 3-month PTE-related deaths and long-term adverse outcomes including 1-year all-cause mortality, rehospitalization due to the recurrence of PTE, right ventricular dysfunction, and pulmonary hypertension. Results: The serum NT-proBNP level and the right ventricular diameter were significantly higher in the patients with adverse outcomes than in the outcome-free patients. Several significant correlations were found between NT-proBNP levels and echocardiographic indices. During a mean follow-up time of 12 months, 1 patient suffered PTE relapse, 15 patients had right ventricular dysfunction and pulmonary hypertension, and 2 patients expired. Age was an independent value in the prediction of the adverse outcome (OR: 1.064, 95% CI: 1.01 to 1.11). Discharge NT-proBNP levels, calculated according to a multiple cutoff point strategy for heart failure, in the PTE patients with adverse outcomes was 2.36 fold that in the outcome-free patients. The optimal value for discharge NTproBNP according to the receiver operating characteristic analysis was 327 pg/mL, with a sensitivity of 80% and a specificity of 43%. Conclusions: NT-proBNP measurement during the course of PTE, especially on discharge, may have a role as an easy-to-use diagnostic tool for determining patients with poor prognoses.