Prognostic value of NT-proBNP, adrenomedullin, copeptin and proenkephalin in patients with pulmonary hypertension

Pulmonary hypertension: course and prognosis 749 Figure 1. Adjusted survival curves associated with worse survival from all-cause mortality was >35 mmHg and the mortality rate increased with increased sPAP. P3533 | BEDSIDE Extrinsic left main coronary artery compression by dilated pulmonary artery in patients with pulmonary hypertension: case series in a single PH referral center R.G. Badea, R. Enache, D. Dorobantu, C. Gavrila, T. Radu, P. Platon, B.A. Popescu, I.M. Coman, C. Ginghina. Institute of Cardiovascular Diseases Prof. C.C. Iliescu, Cardiology, Bucharest, Romania Background: Pulmonary artery (PA) dilation is a common consequence of pulmonary hypertension (PH) and it may reach aneurysmal dimensions. Compression of the left main coronary artery (LMCA) is a rare complication of PA dilation. Data on its diagnosis, management and outcomes are scarce. Purpose: We report the clinical characteristics and outcomes of PH patients with LMCA extrinsic compression in a single PH referral center. Methods: All PAH patients referred to a single tertiary center were reviewed. Clinical and imaging data were retrospectively obtained and patients with documented LMCA compression on coronarography were selected. Results: We report a series of 10 PH patients with LMCA compression, 8 females, mean age 42 (19–57) years at the time of the invasive diagnosis. Diagnoses included PH associated with congenital heart disease (n=8), chronic postembolic PH associated with thrombophilia (n=1) and systemic sclerosis (n=1) and a total of 5 patients were symptomatic for angina. The other 5 patients underwent coronarography because of the severely dilated PA. Coronarography showed LMCA pencil-tip-shape stenosis ranging from 30% to 90%. Significant stenosis (>50%) was found in 6 patients and coronary angioplasty (PCI) was performed in 2 cases (stenoses of 70% and 90%). The first patient underwent PCI with a drug-eluting stent and was reevaluated for recurrent angina three years later, when the stent was found to be permeable, but later died. The second patient was discharged after the procedure and died afterwards of unknown causes. None of these two patients received specific PH therapy which was unavailable at that time (2006) in our country. Associated coronary anomalies were identified in 3 cases: a wide LMCA (7 mm), a right coronary artery – main PA fistula, a circumflex artery – left ventricle fistula. None of the fistulae were addressed (no haemodynamic impact). At initial evaluation echocardiography showed dilated PA in all 10 patients: mean 42.1 mm (range 33–73 mm), with a mean PA-to-aorta diameter ratio of 1.37. Cardiac catheterisation revealed significant PH in all patients: average systolic and mean PA pressures 101 (range 67–139) mmHg and 60 (range 40–91) mmHg, respectively. There was no difference in PA diameter or pressures between patients with or without significant LMCA stenosis. There were 4 deaths in total during 10 years follow-up: both patients with PCI Pencil-tip-shaped LMCA stenosis (without specific PH therapy), one patient with a LMCA stenosis of 70% without PCI and one with 40% stenosis due to terminal heart failure. Conclusion: Left main coronary artery compression due to dilated PA in pulmonary hypertension can be significant enough to require intervention. In our series, angioplasty was safely performed with symptomatic relief in these patients. Further studies are needed to establish the role of screening for and treatment of coronary extrinsic compression in patients with pulmonary hypertension. P3534 | BEDSIDE Prognostic value of NT-proBNP, adrenomedullin, copeptin and proenkephalin in patients with pulmonary hypertension J.A. Ribeiro Agostinho, R. Placido, I. Goncalves, T. Guimaraes, P. Carrilho Ferreira, J.S. Marques, D. Silva, N. Lousada, F.J. Pinto, S. Martins. Hospital Universitário de Santa Maria/CHLN, CAML, CCUL,Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal Introduction: Pulmonary hypertension (PH) comprises a group of progressive diseases characterized by an increase in pulmonary vascular resistance, leading to right ventricular dysfunction. Risk stratification is essential for prognostic evaluation and therapeutic decision, making the determination of new biomarkers important. Purpose: To assess the prognostic value of new biomarkers in the prognostic evaluation of patients with PH. Methods: Prospective cohort study of patients (pts) with PH confirmed by hemodynamic evaluation. Pts underwent clinical and laboratory evaluations at baseline and every 3 months. Follow-up lasted for 18 months. NTproBNP and the new biomarkers (adrenomedullin, copeptin and proenkephalin) were measured. The MannWhitney test, Kaplan-Meier survival analysis and Cox regression were used for statistical analysis. Results: Fifty one pts (75% males, mean age: 54±15 years) belonging to all groups of the WHO PH classification were included. At inclusion, all pts were in WHO functional class II or III. During the study period, 17 pts (33%) died. Baseline NTproBNP values were significantly higher in the non-survivors group (1327; 1061–2703pg/ml vs. 353.5; 190–1661pg/ml; p=0.022). The same did not occur for adrenomedullin, copeptin and proenkephalin baseline levels. The maximum NTproBNP, adrenomedullin and copeptin levels recorded during the follow-up period were significantly higher in the non-survivors group [2347.5 (1667–5073.25) pg/ml vs. 642.5 (208.25–4109.5) pg/ml, p=0.007; 53.6 (38.894.2) pg/ml vs. 33.4 (27–48.8) pg/ml, p=0.0075; 20.69 (13.18–35.69) pmol/L vs. 9.97 (6.18–14.74) pmol/L, p=0.022, respectively]. This did not occur for the maximum proenkephalin level. The NT-proBNP level at admission and adremedullin level at 3 months were independent predictors of mortality (HR 2.78, CI95 1.23–6.30, p=0.01; HR 4.36, CI95 1.17–16.2, p=0.03). Conclusion: The maximum level of NTproBNP, adrenomedullin and copeptin during the follow up were associated with higher mortality in pts with PH. NTproBNP level proved to be an independent predictor of mortality in those patients. These results suggest the prognostic importance of these biomarkers in the approach of pts with PH. P3535 | BEDSIDE Cause of death in patients with idiopathic pulmonary arterial hypertension: data from the Swedish pulmonary arterial hypertension registry C. Hjalmarsson1, B. Rundqvist1, J. Multing1, D. Kylhammar2, G. Radegran2, B. Kjellstrom3.1Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden; 2Lund University, Department of Clinical Sciences, Cardiology, Lund, Sweden; 3Karolinska Institute, Cardiology Unit, Department of Medicine, Stockholm, Sweden Background: Cause of death in patients with idiopathic pulmonary hypertension (IPAH) has not been extensively studied previously. In early clinical trials, the mean age of enrolled IPAH patients has been under 65 years. However, more recent reports show an increasing proportion of IPAH patients ≥65 years. Mortality among older compared to younger IPAH patients is very high. Whether PAHrelated death is less common in elderly than younger IPAH patients in not known. Aim: The aim of this study was to investigate the cause of death and the effect of comorbidity on survival in IPAH patients <65y compared to those ≥65y. Methods: The analysis included 150 patients with age <65y and 180 patients Downloaded from https://academic.oup.com/eurheartj/article-abstract/38/suppl_1/ehx504.P3534/4090038 by Faculdade de Medicina de Lisboa user on 12 October 2018