Relationship between biomarkers and hemodynamic response during exercise stress echocardiography following pulmonary embolism
B Morvai-Illes, S Jdid Mahmoud, L Saghy, P Bencsik, A Gorbe, A Varga, T Szili-Torok, G AgostonAbstract
Introduction
After pulmonary embolism (PE), patients often complain of dyspnea and exercise intolerance. Resting echocardiography frequently does not show clear abnormalities. If complete recanalization of the pulmonary arteries does not occur despite effective anticoagulation, Exercise Doppler Echocardiography (EDE) can demonstrate elevated pulmonary pressure and right ventricular (RV) dysfunction. Inflammatory markers can indicate remodeling of the pulmonary vasculature, while NT-proBNP may suggest heart failure.
Objectives
To demonstrate the correlation between IL-6 and NT-proBNP levels measured synchronously during EDE after 3 months of effective anticoagulation following PE
Methods
Twenty patients (average age: 56±13 years, 21 females, 43%) who had experienced acute PE were included after at least three months of effective anticoagulation. Major exclusion criteria included echocardiographic signs of resting pulmonary hypertension (PH), reduced left ventricular (LV) function, moderate or severe aortic and/or mitral valve disease, interstitial lung disease, and inability to perform physical exertion. All patients underwent EDE, with the load increased by 25 watts every 2 minutes. Parameters were recorded at rest, at 50 watts, and at peak stress. The focus was primarily on RV parameters, such as estimated pulmonary artery systolic pressure (PASP), pulmonary vascular resistance (PVR), TAPSE, and the TAPSE/PASP ratio. NT-proBNP and IL-6 levels were measured immediately prior to the examination.
Results
At peak exercise, PASP and cardiac output significantly increased (28±14 mmHg vs 40±16 mmHg, p<0.001; 5.2±1.8 L/min vs 11±3.2 L/min, p<0.001), while the TAPSE/PASP ratio and PVR significantly decreased (1.11±0.7 vs 0.8±0.5, p<0.0001; 1.3±0.4 Wood vs 1.2±0.3 Wood, p<0.001). The E/e’ value, indicating left ventricular filling pressure, also increased with exertion (7.86±2.8 vs 10.5±3.9, p<0.001). The NT-proBNP level was above the normal range in 60% of patients (217±199 pg/ml) and correlated with resting PASP and PVR (r 0.67, p<0.005; r 0.55, p<0.05), but showed no association with exercise parameters. NT-proBNP did not correlate with the E/e’ ratio. IL-6 level did not relate to left ventricular filling pressure or RV resting or stress parameters.
Conclusion
The NT-proBNP level can be elevated after PE, even in the absence of PH, and shows a close correlation with resting hemodynamic parameters of the right heart. Abnormal pulmonary pressure elevation can occur post-PE without resting pulmonary arterial hypertension; however, this is not predicted by NT-proBNP levels.Pulmonary pressure changes and correlation