[The utility of assaying the N-terminal of brain natriuretic peptide precursor (NT pro-BNP) to predict the clinical outcome in patients with supraventricular tachyarrhythmias observed and treated in the emergency room]. / Utilità del dosaggio del precursore del peptide natriuretico cerebrale come predittore di cardioversione efficace nei pazienti con tachicardie e tachiaritmie sopraventricolari, osservati e trattati in Pronto Soccorso.

ABSTRACT

Many patients arrive at the emergency room (ER) with recent-onset atrial fibrillation or other forms of supraventricular tachyarrhythmia (SV Ta) or tachycardia. The restoration of sinus rhythm (SR) is always desirable and, in addition, can enable many hospitalisations to be avoided, thereby achieving considerable savings in financial and healthcare resources. Even in haemodynamically stable cases, it is clearly useful to be able to evaluate which subjects will benefit most from attempts to restore SR, even when few truly diagnostic means are on hand (such as echocardiography, which is not always promptly available in the ER setting). We evaluated the brain natriuretic peptide precursor (N terminal pro-BNP) in 105 patients arriving at the ER. We observed that SR was restored in a low percentage of patients with values > 4500, while the vast majority of those with values < 1500 was normalised even by means of antiarrhythmic drugs alone. It is therefore probable that a medium-low value of the hormone indicates only an acute response to the distension of the atrial tissue induced by the arrhythmia; by contrast, decidedly elevated values are probably also caused by ventricular dysfunction and therefore indicate a lesser likelihood of restoring SR. The routine evaluation of NT pro-BNP could be used as an alternative to echocardiography in order to rapidly select patients in whom cardioversion should be attempted in the ER or Brief Observation Unit.