• Stacy E F Melanson, Michael Laposata, Carlos A Camargo, Annabel A Chen, Roderick Tung, Dan Krauser, Saif Anwaruddin, Aaron Baggish, Renee Cameron, Patrick Sluss, Kent B Lewandrowski, Elizabeth Lee-Lewandrowski, and James L Januzzi.
• Department of Pathology, Division of Clinical Laboratories, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass, USA.
• Arch. Pathol. Lab. Med. 2006 Sep 1; 130 (9): 1326-9.

ContextD-dimer concentration can be used to exclude a diagnosis of acute pulmonary embolism. However, clinicians frequently order unnecessary supplemental testing in patients with low concentrations of D-dimer. Elevations in natriuretic peptides have also been described in the setting of pulmonary embolism.ObjectiveWe investigated the integrative role of D-dimer with amino-terminal pro-B-type natriuretic peptide for the evaluation of patients with and without acute pulmonary embolism.DesignPatients were selected for analysis from a previous study in which levels of D-dimer and amino-terminal pro-B-type natriuretic peptide were measured. The presence of pulmonary embolism was determined by computed tomographic angiography.ResultsThe median levels of D-dimer were significantly higher in patients with acute pulmonary embolism. Similarly, the median levels of amino-terminal pro-B-type natriuretic peptide were higher in patients with pulmonary embolism.ConclusionsThe Roche Tina-quant D-Dimer immunoturbidimetric assay provides a high negative predictive value and can be used to exclude acute pulmonary embolism in patients with dyspnea. Measurement of amino-terminal pro-B-type natriuretic peptide in addition to D-dimer improves specificity for acute pulmonary embolism without sacrificing negative predictive value. A combination of both markers may offer reassurance for excluding acute pulmonary embolism, and thus avoid redundant, expensive confirmatory tests.

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