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
Purpose: The severity of pulmonary embolism (PE) isdetermined by its associated degree of right ventricular dysfunction(RVD). In normotensive PE, the presence of RVDmakes the prognosis worse and generally leads to considerationof fibrinolysis treatment. Routine usage of echocardiograhyin the diagnosis of RVD associated with PE is limitedin the emergency department (ED). We evaluated theusefulness of B-type natriuretic peptide (BNP) and troponinI (TnI) levels for the diagnosis of right ventricular dysfunctionin patients with normotensive PE and we suggest a cutoffvalue.Methods: Forty-five patients who visited the ED of AsanMedical Center from January 2003 to December 2006 andwere confirmed with PE were retrospectively recruited. Weexcluded patients with heart failure or chronic renal failure.The cut-off values of BNP and TnI for diagnosis of RVD innormotensive PE were determined by receiver operatingcharacteristic curve (ROC) analysis.Results: The cut-off value of BNP and TnI for the diagnosisof RVD were 149 pg/ml and 0.2 ng/ml, respectively, and thearea under the ROC curve were 0.87(95% CI, 0.70-0.96)and 0.85(0.68~0.95). There were no significant differencesin diagnostic accuracy between BNP and TnI (p=0.841).Conclusion: In patients with normotensive PE, BNP andTnI were useful diagnostic test of RVD. The significant differencein diagnostic accuracy between BNP and TnI wasnot found. When BNP or TnI is elevated in normotensivePE patients, physician should consider RVD and suggestfurther evaluations.
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