What question did this study set out to answer?

To evaluate the association between elevated B-type natriuretic peptides, alone or combined with troponins, and mortality, serious adverse events, and right ventricular dysfunction in acute pulmonary embolism.

June 11, 2009ThoraxOpen Access

Natriuretic peptides and troponins in pulmonary embolism: a meta-analysis

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Why the study?

Are raised natriuretic peptide levels associated with increased mortality and adverse events in patients with acute pulmonary embolism?

Population

23 studies including 1,127 patients with acute pulmonary embolism (APE)

Comparison

Raised natriuretic peptide levels, alone or in… vs Normal/non-raised natriuretic peptide levels

Design

Meta-analysis

Authors

JLJ.-C. LegaUniversité Claude Bernard Lyon 1 YLYves LacasseInstitut Universitaire de Cardiologie et de Pneumologie de Québec LLLajmi LakhalInstitut Universitaire de Cardiologie et de Pneumologie de Québec

Discussion

Member takes

Implication

May support risk stratification in acute PE; leaves open whether testing improves outcomes in prospective trials.

Key Points

To evaluate the association between elevated B-type natriuretic peptides, alone or combined with troponins, and mortality, serious adverse events, and right ventricular dysfunction in acute pulmonary embolism.
Searched MEDLINE, EMBASE, and conference abstracts through February 2008.
Included 23 studies comprising 1,127 patients with acute pulmonary embolism and available 2x2 contingency data for natriuretic peptides and clinical outcomes.
Raised natriuretic peptide levels were significantly associated with all-cause mortality (OR 6.2; 95% CI 3.0 to 12.7) and pulmonary embolism-related mortality (OR 5.0; 95% CI 2.2 to 11.5).
Elevated natriuretic peptides correlated with serious adverse events (OR 6.7; 95% CI 3.9 to 11.6), with concurrent troponin elevations further increasing adverse outcome risks.
BNP demonstrated higher sensitivity and specificity than NT-proBNP for detecting right ventricular dysfunction, though overall analysis was limited by inter-study heterogeneity.

Structured PICO

Are raised natriuretic peptide levels associated with increased mortality and adverse events in patients with acute pulmonary embolism?

Population

23 studies including 1,127 patients with acute pulmonary embolism (APE)

Intervention

Raised natriuretic peptide levels (BNP and NT-proBNP), alone or in conjunction with troponins

Comparator

Normal/non-raised natriuretic peptide levels

Outcome

All-cause mortality, APE-related mortality, serious adverse events, and echographic right ventricular dysfunctionhard clinical

Raised B-type natriuretic peptides, especially when combined with increased troponins, identify patients with acute pulmonary embolism at higher risk of mortality and serious adverse events.

Limitations

Heterogeneity across studies in detecting right ventricular dysfunction

Cite This Study

Lega et al. (2009) studied this question.

synapsesocial.com/papers/6a907a21e02ba012352dc122 https://doi.org/10.1136/thx.2008.110965

Topics

Pulmonary embolism

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Natriuretic peptides and troponins in pulmonary embolism: a meta-analysis

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Cite This Study

Topics

Natriuretic peptides and troponins in pulmonary embolism: a meta-analysis

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Cite This Study

Also Consider

Topics

Also Consider