Combination of D-dimer and amino-terminal pro-B-type natriuretic Peptide testing for the evaluation of dyspneic patients with and without acute pulmonary embolism.

Published

Journal Article

CONTEXT: D-dimer concentration can be used to exclude a diagnosis of acute pulmonary embolism. However, clinicians frequently order unnecessary supplemental testing in patients with low concentrations of D-dimer. Elevations in natriuretic peptides have also been described in the setting of pulmonary embolism. OBJECTIVE: We investigated the integrative role of D-dimer with amino-terminal pro-B-type natriuretic peptide for the evaluation of patients with and without acute pulmonary embolism. DESIGN: Patients were selected for analysis from a previous study in which levels of D-dimer and amino-terminal pro-B-type natriuretic peptide were measured. The presence of pulmonary embolism was determined by computed tomographic angiography. RESULTS: The median levels of D-dimer were significantly higher in patients with acute pulmonary embolism. Similarly, the median levels of amino-terminal pro-B-type natriuretic peptide were higher in patients with pulmonary embolism. CONCLUSIONS: The Roche Tina-quant D-Dimer immunoturbidimetric assay provides a high negative predictive value and can be used to exclude acute pulmonary embolism in patients with dyspnea. Measurement of amino-terminal pro-B-type natriuretic peptide in addition to D-dimer improves specificity for acute pulmonary embolism without sacrificing negative predictive value. A combination of both markers may offer reassurance for excluding acute pulmonary embolism, and thus avoid redundant, expensive confirmatory tests.

Full Text

Duke Authors

Cited Authors

  • Melanson, SEF; Laposata, M; Camargo, CA; Chen, AA; Tung, R; Krauser, D; Anwaruddin, S; Baggish, A; Cameron, R; Sluss, P; Lewandrowski, KB; Lee-Lewandrowski, E; Januzzi, JL

Published Date

  • September 2006

Published In

Volume / Issue

  • 130 / 9

Start / End Page

  • 1326 - 1329

PubMed ID

  • 16948519

Pubmed Central ID

  • 16948519

Electronic International Standard Serial Number (EISSN)

  • 1543-2165

Digital Object Identifier (DOI)

  • 10.1043/1543-2165(2006)130[1326:CODAAP]2.0.CO;2

Language

  • eng

Conference Location

  • United States