Gutte Henrik
Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Copenhagen University Hospital. Blegdamsvej, 2100 Copenhagen, Denmark.
Dan Med Bull. 2011 Mar;58(3):B4258.
Acute pulmonary embolism (PE) is a severe and potentially fatal disease which acutely augments the right ventricle (RV) strain. Development of RV dysfunction (RVD) in the disease process is synonymous with an overall poor prognosis. The diagnosis of PE is usually established by a combination of clinical assessment, D-dimer test and medical imaging with either lung scintigraphy or pulmonary multidetector computer tomography (MDCT) angiography. Which of the two methods to use in PE diagnostic has not been determined and very limited data comparing these modalities are available. Assessment of RV function is cumbersome due to complex geometry. RVD is usually established by echocardiography which is observer dependent, has low reproducibility, and requires expertise. Therefore, a simple and reproducible biochemical method to assess RVD in patients with PE would be desirable. Brain natriuretic peptide (BNP), pro-atrial natriuretic peptide (pro-ANP), cardiac troponin I (TnI), and endothelin-1 (ET-1) have been the most studied plasma biomarkers in the context of risk stratification in PE. BNP is mainly produced in the ventricles of the heart. It is released from the left ventricle in response to increased filling pressure and is increased in chronic left heart failure. Pro-ANP is primarily produced in the atria, is released by atrial distention and is elevated in chronic pulmonary hypertension and could be an early marker for RVD. Plasma level of ET-1 has been shown to correlate with pulmonary pressure and is released from endothelial cells in the pulmonary vessels. Additionally, increases in circulating levels of ET-1 have been reported in an experimental animal model of PE. TnI is part of a complex of regulatory proteins in the cardiac myofilaments and is released upon myocyte injury. It is related to short term clinical outcome, prolonged hypotension, and cardiogenic shock after myocardial infarction and is a predictor of 30-day mortality and RVD using echocardiography in patients with PE. Our hypothesis was therefore that the neuroendocrine activation of BNP, pro-ANP, ET-1, and TnI alone or in combination could serve as markers of RVD in patients with PE. The use of plasma biomarkers would be much simpler than reproducible medical imaging methods such as magnetic resonance imaging (MRI), radionuclide based methods etc.
急性肺栓塞（PE）是一种严重且可能致命的疾病，会急性增加右心室（RV）负荷。疾病过程中右心室功能障碍（RVD）的出现意味着总体预后不良。PE的诊断通常通过临床评估、D - 二聚体检测以及肺闪烁扫描或肺部多排计算机断层扫描（MDCT）血管造影等医学成像相结合来确定。在PE诊断中使用这两种方法中的哪一种尚未确定，并且比较这些方式的可用数据非常有限。由于右心室几何形状复杂，评估其功能很麻烦。RVD通常通过超声心动图来确定，而超声心动图依赖观察者，重现性低，且需要专业知识。因此，需要一种简单且可重复的生化方法来评估PE患者的RVD。脑钠肽（BNP）、心房利钠肽原（pro - ANP）、心肌肌钙蛋白I（TnI）和内皮素 - 1（ET - 1）是在PE风险分层背景下研究最多的血浆生物标志物。BNP主要在心脏心室产生。它在左心室因充盈压升高而释放，在慢性左心衰竭时升高。pro - ANP主要在心房产生，由心房扩张释放，在慢性肺动脉高压时升高，可能是RVD的早期标志物。已证明血浆ET - 1水平与肺动脉压力相关，且从肺血管内皮细胞释放。此外，在PE实验动物模型中已报道循环中ET - 1水平升高。TnI是心肌肌丝中调节蛋白复合物的一部分，在心肌细胞损伤时释放。它与心肌梗死后的短期临床结果、持续性低血压和心源性休克有关，并且是PE患者使用超声心动图评估30天死亡率和RVD的预测指标。因此，我们的假设是，单独或联合使用BNP、pro - ANP、ET - 1和TnI的神经内分泌激活可作为PE患者RVD的标志物。使用血浆生物标志物比诸如磁共振成像（MRI）、基于放射性核素的方法等可重复的医学成像方法要简单得多。
