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

Pulmona y hype ension: cou se and p ognosis 749 Figu e 1. Adjus ed su i al cu es associa ed wi h wo se su i al om all-cause mo ali y was >35 mmHg and he mo ali y a e inc eased wi h inc eased sPAP. P3533 | BEDSIDE Ex insic le main co ona y a e y comp ession by dila ed pulmona y a e y in pa ien s wi h pulmona y hype ension: case se ies in a single PH e e al cen e R.G. Badea, R. Enache, D. Do oban u, C. Ga ila, T. Radu, P. Pla on, B.A. Popescu, I.M. Coman, C. Ginghina. Ins i u e o Ca dio ascula Diseases P o . C.C. Iliescu, Ca diology, Bucha es , Romania Backg ound: Pulmona y a e y (PA) dila ion is a common consequence o pul- mona y hype ension (PH) and i may each aneu ysmal dimensions. Comp es- sion o he le main co ona y a e y (LMCA) is a a e complica ion o PA dila ion. Da a on i s diagnosis, managemen and ou comes a e sca ce. Pu pose: We epo he clinical cha ac e is ics and ou comes o PH pa ien s wi h LMCA ex insic comp ession in a single PH e e al cen e . Me hods: All PAH pa ien s e e ed o a single e ia y cen e we e e iewed. Clini- cal and imaging da a we e e ospec i ely ob ained and pa ien s wi h documen ed LMCA comp ession on co ona og aphy we e selec ed. Resul s: We epo a se ies o 10 PH pa ien s wi h LMCA comp ession, 8 e- males, mean age 42 (19–57) yea s a he ime o he in asi e diagnosis. Di- agnoses included PH associa ed wi h congeni al hea disease (n=8), ch onic pos embolic PH associa ed wi h h ombophilia (n=1) and sys emic scle osis (n=1) and a o al o 5 pa ien s we e symp oma ic o angina. The o he 5 pa ien s un- de wen co ona og aphy because o he se e ely dila ed PA. Co ona og aphy showed LMCA pencil- ip-shape s enosis anging om 30% o 90%. Significan s enosis (>50%) was ound in 6 pa ien s and co ona y angioplas y (PCI) was pe - o med in 2 cases (s enoses o 70% and 90%). The fi s pa ien unde wen PCI wi h a d ug-elu ing s en and was ee alua ed o ecu en angina h ee yea s la e , when he s en was ound o be pe meable, bu la e died. The second pa- ien was discha ged a e he p ocedu e and died a e wa ds o unknown causes. None o hese wo pa ien s ecei ed specific PH he apy which was una ailable a ha ime (2006) in ou coun y. Associa ed co ona y anomalies we e iden ified in 3 cases: a wide LMCA (7 mm), a igh co ona y a e y – main PA fis ula, a ci cumflex a e y – le en icle fis ula. None o he fis ulae we e add essed (no haemodynamic impac ). A ini ial e alua ion echoca diog aphy showed dila ed PA in all 10 pa ien s: mean 42.1 mm ( ange 33–73 mm), wi h a mean PA- o-ao a diame e a io o 1.37. Ca - diac ca he e isa ion e ealed significan PH in all pa ien s: a e age sys olic and mean PA p essu es 101 ( ange 67–139) mmHg and 60 ( ange 40–91) mmHg, e- spec i ely. The e was no di e ence in PA diame e o p essu es be ween pa ien s wi h o wi hou significan LMCA s enosis. The e we e 4 dea hs in o al du ing 10 yea s ollow-up: bo h pa ien s wi h PCI Pencil- ip-shaped LMCA s enosis (wi hou specific PH he apy), one pa ien wi h a LMCA s enosis o 70% wi hou PCI and one wi h 40% s enosis due o e minal hea ailu e. Conclusion: Le main co ona y a e y comp ession due o dila ed PA in pul- mona y hype ension can be significan enough o equi e in e en ion. In ou se- ies, angioplas y was sa ely pe o med wi h symp oma ic elie in hese pa ien s. Fu he s udies a e needed o es ablish he ole o sc eening o and ea men o co ona y ex insic comp ession in pa ien s wi h pulmona y hype ension. P3534 | BEDSIDE P ognos ic alue o NT-p oBNP, ad enomedullin, copep in and p oenkephalin in pa ien s wi h pulmona y hype ension J.A. Ribei o Agos inho, R. Placido, I. Goncal es, T. Guima aes, P. Ca ilho Fe ei a, J.S. Ma ques, D. Sil a, N. Lousada, F.J. Pin o, S. Ma ins. Hospi al Uni e si á io de San a Ma ia/CHLN, CAML, CCUL,Faculdade de Medicina, Uni e sidade de Lisboa, Lisbon, Po ugal In oduc ion: Pulmona y hype ension (PH) comp ises a g oup o p og essi e diseases cha ac e ized by an inc ease in pulmona y ascula esis ance, lead- ing o igh en icula dys unc ion. Risk s a ifica ion is essen ial o p ognos ic e alua ion and he apeu ic decision, making he de e mina ion o new bioma ke s impo an . Pu pose: To assess he p ognos ic alue o new bioma ke s in he p ognos ic e alua ion o pa ien s wi h PH. Me hods: P ospec i e coho s udy o pa ien s (p s) wi h PH confi med by hemo- dynamic e alua ion. P s unde wen clinical and labo a o y e alua ions a baseline and e e y 3 mon hs. Follow-up las ed o 18 mon hs. NTp oBNP and he new bioma k- e s (ad enomedullin, copep in and p oenkephalin) we e measu ed. The Mann- Whi ney es , Kaplan-Meie su i al analysis and Cox eg ession we e used o s a is ical analysis. Resul s: Fi y one p s (75% males, mean age: 54±15 yea s) belonging o all g oups o he WHO PH classifica ion we e included. A inclusion, all p s we e in WHO unc ional class II o III. Du ing he s udy pe iod, 17 p s (33%) died. Base- line NTp oBNP alues we e significan ly highe in he non-su i o s g oup (1327; 1061–2703pg/ml s. 353.5; 190–1661pg/ml; p=0.022). The same did no occu o ad enomedullin, copep in and p oenkephalin baseline le els. The maximum NTp oBNP, ad enomedullin and copep in le els eco ded du ing he ollow-up pe- iod we e significan ly highe in he non-su i o s g oup [2347.5 (1667–5073.25) pg/ml s. 642.5 (208.25–4109.5) pg/ml, p=0.007; 53.6 (38.8- 94.2) pg/ml s. 33.4 (27–48.8) pg/ml, p=0.0075; 20.69 (13.18–35.69) pmol/L s. 9.97 (6.18–14.74) pmol/L, p=0.022, espec i ely]. This did no occu o he maximum p oenkephalin le el. The NT-p oBNP le el a admission and ad emedullin le el a 3 mon hs we e independen p edic o s o mo ali y (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 le el o NTp oBNP, ad enomedullin and copep in du - ing he ollow up we e associa ed wi h highe mo ali y in p s wi h PH. NTp oBNP le el p o ed o be an independen p edic o o mo ali y in hose pa ien s. These esul s sugges he p ognos ic impo ance o hese bioma ke s in he app oach o p s wi h PH. P3535 | BEDSIDE Cause o dea h in pa ien s wi h idiopa hic pulmona y a e ial hype ension: da a om he Swedish pulmona y a e ial hype ension egis y C. Hjalma sson1, B. Rundq is 1, J. Mul ing1, D. Kylhamma 2, G. Radeg an2, B. Kjells om3.1Sahlg enska Uni e si y Hospi al, Depa men o Ca diology, Go henbu g, Sweden; 2Lund Uni e si y, Depa men o Clinical Sciences, Ca - diology, Lund, Sweden; 3Ka olinska Ins i u e, Ca diology Uni , Depa men o Medicine, S ockholm, Sweden Backg ound: Cause o dea h in pa ien s wi h idiopa hic pulmona y hype ension (IPAH) has no been ex ensi ely s udied p e iously. In ea ly clinical ials, he mean age o en olled IPAH pa ien s has been unde 65 yea s. Howe e , mo e ecen epo s show an inc easing p opo ion o IPAH pa ien s ≥65 yea s. Mo al- i y among olde compa ed o younge IPAH pa ien s is e y high. Whe he PAH- ela ed dea h is less common in elde ly han younge IPAH pa ien s in no known. Aim: The aim o his s udy was o in es iga e he cause o dea h and he e ec o como bidi y on su i al in IPAH pa ien s <65y compa ed o hose ≥65y. Me hods: The analysis included 150 pa ien s wi h age <65y and 180 pa ien s Downloaded om h ps://academic.oup.com/eu hea j/a icle-abs ac /38/suppl_1/ehx504.P3534/4090038 by Faculdade de Medicina de Lisboa use on 12 Oc obe 2018