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To the Editor:In the study by Kucher et al,1 the authors concluded that a low type B natriuretic peptide (BNP) level identifies patients at low risk for adverse events and that they may be candidates for outpatient care. However, clinicians need to consider the time interval between the pulmonary embolism event and BNP, or pro-BNP, measurement when interpreting these results. BNP levels may not correlate well with other cardiovascular or clinical measures in patients with illness of acute onset because of a delay in BNP mRNA upregulation.2,3In a recent study, we measured BNP levels …

Use of Natriuretic Peptides in Guiding Treatment Decisions for Acute Pulmonary Embolism