Age-adjusted cut-off values of natriuretic peptides for right ventricular dysfunction in acute pulmonary embolism: Post-hoc analysis from CURES.

Background: Cut-off values of natriuretic peptides [NPs, including B-type natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP)] for right ventricular dysfunction (RVD) in acute pulmonary embolism (PE) are not standardized.

Methods: Patients with acute PE enrolled between 2016 and 2021 were selected from a large prospective nationwide cohort in China. Patients with available values of NPs were included. RVD was confirmed by echocardiography or computed tomography pulmonary angiography. We used receiver operating characteristic curves to determine optimal cut-off values. Kaplan-Meier curves and log-rank test were performed to show the association between NPs and 30-day all-cause mortality, stratified by these thresholds.

Results: A total of 4105 patients (median age, 65 years; 50.5 % male) were enrolled, with 743 (18.1 %) developing RVD. The optimal NT-proBNP threshold for RVD was identified as 641 pg/ml, yielding an area under the curve (AUC) of 0.713 (95 % CI 0.686-0.740). For individuals aged <55, 55-69, and ≥ 70 years, the cut-off values were 356 pg/ml, 526 pg/ml, and 647 pg/ml, with AUCs of 0.750, 0.712, and 0.689, respectively. The optimal cut-off value of BNP was 194 pg/ml, with an AUC of 0.679 (95 % CI 0.647-0.712). Age-adjusted thresholds were 83 pg/ml, 146 pg/ml, and 200 pg/ml, with AUCs of 0.705, 0.699, and 0.646, respectively. All thresholds demonstrated negative predictive value approximately 0.9 (range: 0.884-0.916). Elevated NPs based on thresholds for the rounded tens were associated with an increased risk of death within 30 days.

Conclusions: Age-adjusted NP thresholds offer improved RVD detection. Physicians should emphasize the importance of NPs in acute PE.