Pulmonary embolism: role of echocardiography and of biological markers.

Echocardiography and biomarkers: what should be their place in the algorithms designed for pulmonary embolism (PE)? Our opinions on that continue to evolve. This manuscript attempts a snapshot reflecting the position of cardiac imaging and cardiac biomarkers in suspected and confirmed PE. Comparing the prognostic performance of brain natriuretic peptide (BNP) and troponins, it seems that with thresholds set appropriately high, troponins could be more helpful in the identification of patients with adverse prognosis while low BNP levels are reliable markers of good prognosis. Because of the relatively short plasma half-life, BNP as well as NT-proBNP could be repeated to monitor evolution of the hemodynamic status of the patient and the results of implemented treatment. The role of echocardiography outside massive PE seems to be decreasing, although if considered together with information provided on potential alternative or additional cardiovascular diseases as well as intracardiac or intravascular thrombi, its place in a tentative management algorithm in PE seems still secured.