1. Title1 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 (marzial76@yahoo.it); (b) University of Turin, Turin, Italy

2. Title>Background2 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.

3. Title>Background>Aim3 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.

4. 4 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>Methods4

5. 5 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>Methods5

6. 6 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>Results6

7. 7 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>Results7

8. 8 PLOTS Title>Background>Aim>Methods>Results8

9. 9 PLOTS Title>Background>Aim>Methods>Results9

10. 10 PLOTS Title>Background>Aim>Methods>Results10

11. 11 PLOTS Title>Background>Aim>Methods>Results11

12. 12 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>Conclusions12

13. Thank you for your attention For any correspondence: marzial76@yahoo.it For further slides on these topics feel free to visit the metcardio.org website: http://www.metcardio.org/slides.html marzial76@yahoo.it http://www.metcardio.org/slides.html