D-dimer/NT-proBNP ratio in acute pulmonary embolism patients stratifies risk of chronic thromboembolic pulmonary hypertension
- 1Department of Internal Medicine and Cardiology, Center for Management of Venous Thromboembolic Disease, Medical University of Warsaw, Warsaw, Poland.
- 2These authors contributed equally to this work.
- 3Department of Radiology, Medical University of Warsaw, Warsaw, Poland.
Abstract
Background
There are ongoing efforts to identify patients at risk of chronic thromboembolic pulmonary hypertension (CTEPH) during acute pulmonary embolism (APE). Lower D-dimer levels and right heart overload at APE diagnosis were reported to predict CTEPH. We hypothesised that plasma D-dimer to N-terminal pro-B type natriuretic peptide (NT-proBNP) ratio assessed during APE may be useful for early CTEPH screening.Methods
We followed 342 APE survivors (median age 64.5 years, female 56.1%), for a median of 39 (25-64) months.Results
Despite ≥3 months anticoagulation CTEPH was diagnosed in 22 (6.4%) patients (CTEPH(+)). At APE diagnosis, CTEPH(+) compared with subjects without this sequela (CTEPH(-)) presented with advanced right ventricular overload: increased tricuspid regurgitation peak gradient (TRPG) (46.5 mmHg versus 32.0 mmHg; p<0.001) and NT-proBNP (1860 ng·L⁻¹ versus 515 ng·L⁻¹; p=0.02). Despite no differences in plasma D-dimer (4210 μg·L⁻¹ versus 5330 μg·L⁻¹; p=0.10), the ratio of D-dimer to NT-proBNP (DD/NT-proBNP) was significantly lower in the CTEPH(+) cohort versus the CTEPH(-) cohort (2.89 μg·ng⁻¹ versus 12.0 μg·ng⁻¹; p<0.001). In patients with DD/NT-proBNP≤10 CTEPH was diagnosed in 20 cases (11.7%), whereas in the group with DD/NT-proBNP> 10 CTEPH could only be detected in 2 of 171 cases (1.2%) with an OR 0.09 (95% confidence interval (CI) 0.02-0.38; p=0.0013), a sensitivity of 90.9% (95% CI 70.8-98.9%), a specificity 52.8% (95% CI 47.2-58.4%), a negative predictive value 98.8% (95% CI 95.8-99.9%), a and positive predictive value of 11.7% (95% CI 7.3-17.5%). Combination of DD/NT-proBNP≤10 with TRPG≥36 mmHg detected in 87 patients, including 17 patients with CTEPH (19.5% CTEPH incidence).Conclusion
DD/NT-proBNP>10 μg·ng⁻¹ identifies patients with a low risk of subsequent CTEPH diagnosis, whereas DD/NT-proBNP≤10, especially presenting TRPG≥36 mmHg at echocardiography, forms a high risk group at follow-up.
Related
- Evaluating preoperative imaging in patients with chronic thromboembolic pulmonary hypertension: Is computed tomography pulmonary angiography a reliable alternative to pulmonary angiography?
- Comparison of Clinical, Hemodynamic and Imaging Profiles Between Isolated Pulmonary Vasculitis and Chronic Thromboembolic Pulmonary Hypertension
- Obstructive Sleep Apnea and Pulmonary Embolism: Prevalence, Severity and the Association of Sleep-Disordered Breathing with Thromboembolic Disease
- Reduction in Right Ventricular Stroke Work Index After Balloon Pulmonary Angioplasty is Associated With Long-Term Prognosis in Chronic Thromboembolic Pulmonary Hypertension.
- Obstructive Ventilatory Defects in Pulmonary Arterial Hypertension and Chronic Thromboembolic Pulmonary Hypertension
BibTeX
@article{spychalska2026ddimerntprobnp,
title = {{D-dimer/NT-proBNP ratio in acute pulmonary embolism patients stratifies risk of chronic thromboembolic pulmonary hypertension}},
author = {Katarzyna Spychalska and Mateusz Jermakow and Joanna Kucharska and Olga Dzikowska-Diduch and Katarzyna Perzanowska-Brzeszkiewicz and Iwona Dudzik-Niewiadomska and Andrzej Łabyk and Aisha Ou-Pokrzewińska and Małgorzata Wiśniewska and Marek Roik and Ciurzyński Michał and Piotr Pruszczyk},
journal = {ERJ open research},
year = {2026},
month = nov,
doi = {10.1183/23120541.00580-2026},
url = {https://europepmc.org/article/PMC/PMC13725833},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - D-dimer/NT-proBNP ratio in acute pulmonary embolism patients stratifies risk of chronic thromboembolic pulmonary hypertension
AU - Katarzyna Spychalska
AU - Mateusz Jermakow
AU - Joanna Kucharska
AU - Olga Dzikowska-Diduch
AU - Katarzyna Perzanowska-Brzeszkiewicz
AU - Iwona Dudzik-Niewiadomska
AU - Andrzej Łabyk
AU - Aisha Ou-Pokrzewińska
AU - Małgorzata Wiśniewska
AU - Marek Roik
AU - Ciurzyński Michał
AU - Piotr Pruszczyk
PY - 2026
DA - 2026/11/01
JO - ERJ open research
DO - 10.1183/23120541.00580-2026
UR - https://europepmc.org/article/PMC/PMC13725833
AB - Background There are ongoing efforts to identify patients at risk of chronic thromboembolic pulmonary hypertension (CTEPH) during acute pulmonary embolism (APE). Lower D-dimer levels and right heart overload at APE diagnosis were reported to predict CTEPH. We hypothesised that plasma D-dimer to N-terminal pro-B type natriuretic peptide (NT-proBNP) ratio assessed during APE may be useful for early CTEPH screening.Methods We followed 342 APE survivors (median age 64.5 years, female 56.1%), for a median of 39 (25-64) months.Results Despite ≥3 months anticoagulation CTEPH was diagnosed in 22 (6.4%) patients (CTEPH(+)). At APE diagnosis, CTEPH(+) compared with subjects without this sequela (CTEPH(-)) presented with advanced right ventricular overload: increased tricuspid regurgitation peak gradient (TRPG) (46.5 mmHg versus 32.0 mmHg; p<0.001) and NT-proBNP (1860 ng·L⁻¹ versus 515 ng·L⁻¹; p=0.02). Despite no differences in plasma D-dimer (4210 μg·L⁻¹ versus 5330 μg·L⁻¹; p=0.10), the ratio of D-dimer to NT-proBNP (DD/NT-proBNP) was significantly lower in the CTEPH(+) cohort versus the CTEPH(-) cohort (2.89 μg·ng⁻¹ versus 12.0 μg·ng⁻¹; p<0.001). In patients with DD/NT-proBNP≤10 CTEPH was diagnosed in 20 cases (11.7%), whereas in the group with DD/NT-proBNP> 10 CTEPH could only be detected in 2 of 171 cases (1.2%) with an OR 0.09 (95% confidence interval (CI) 0.02-0.38; p=0.0013), a sensitivity of 90.9% (95% CI 70.8-98.9%), a specificity 52.8% (95% CI 47.2-58.4%), a negative predictive value 98.8% (95% CI 95.8-99.9%), a and positive predictive value of 11.7% (95% CI 7.3-17.5%). Combination of DD/NT-proBNP≤10 with TRPG≥36 mmHg detected in 87 patients, including 17 patients with CTEPH (19.5% CTEPH incidence).Conclusion DD/NT-proBNP>10 μg·ng⁻¹ identifies patients with a low risk of subsequent CTEPH diagnosis, whereas DD/NT-proBNP≤10, especially presenting TRPG≥36 mmHg at echocardiography, forms a high risk group at follow-up.
SN - 2312-0541
ER -