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

Stacy E.F. Melanson, Michael Laposata, Carlos A. Camargo, Annabel A. Chen, Roderick Tung, Dan Krauser, Saif Anwaruddin, Aaron Baggish, Renee Cameron, Patrick Sluss, Kent B. Lewandrowski, Elizabeth Lee-Lewandrowski, James L. Januzzi

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14 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1326-1329
Number of pages4
JournalArchives of Pathology and Laboratory Medicine
Volume130
Issue number9
StatePublished - Sep 1 2006
Externally publishedYes

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ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Medical Laboratory Technology

Cite this

Melanson, S. E. F., Laposata, M., Camargo, C. A., Chen, A. A., Tung, R., Krauser, D., Anwaruddin, S., Baggish, A., Cameron, R., Sluss, P., Lewandrowski, K. B., Lee-Lewandrowski, E., & Januzzi, J. L. (2006). 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. Archives of Pathology and Laboratory Medicine, 130(9), 1326-1329.