Analyse du peptide natriurétique de type B comme marqueur du cœur pulmonaire aigu dans le syndrome de détresse respiratoire aiguë

Objective: The aim of this study was to evaluate the accuracy of the BNP as a marker of acute cor pulmonale in patients with ARDS. Study design: Prospective clinical trial. Patients and methods: At day 2 or 3 after the onset of the ARDS, an echocardiography was performed. Patients with left ventricular dysfunction were excluded. Right ventricular area (RVA) and RVA/LVA ratio were measured. ACP was defined as RVA/LVA > 0.6 associated with septal dyskinesia. Simultaneously, 5 ml of blood was collected for BNP measurement. Results: 26 patients were studied. BNP levels were higher in 10 patients with ACP: 585.5 [189-4830] vs 145.5 [36.5-346] pg/ml (P = 0.01) but in those with creatinine clearance < 90 ml/min: 602 [331-3530] vs 125 [39-189] pg/ml (P = 0.007). BNP was correlated with RVA (r = 0.5; p = 0.01), RVA/LVA ratio (r = 0.61; p = 0.001), sPAP (r = 0.58; p = 0.002) and with age, cardiac index and creatinine clearance (r = 0.61; p = 0.001). In multivariate analysis, BNP was only correlated with creatinine clearance (p = 0.03), and RVA (p = 0.06). Conclusion: In ARDS patients without left ventricular dysfunction, BNP level is more elevated in patients with acute cor pulmonale than patients without cor pulmonale.