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531: Brain Natriuretic Peptide Levels: The Canary in the Right Ventricular Mine in Pulmonary Arterial Hypertension
S250
Abstracts
529 Simultaneous Measurement of Serum N-Terminal Brain Natriuretic Peptide and Troponin T in Risk Assessment of Pateints with Precapillary Pulmonary Hypertension A.K. Andreassen1, S. Arora1, E. Gude1, O.G. Solberg1, R. Wergeland2 1Rikshospitalet University Hospital, Oslo, Norway; 2 Rikshospitalet Univeristy Hospital, Oslo, Norway Purpose: While various markers of disease severity have been applied in risk assessement in patients with precapillary pulmonary hypertension, limited data exists on the simultaneous application of two biomarkers. We evaluated the prognostic value of combined use of serum levels of TnT and NT-proBNP in a group of patients with idopathic pulmonary arterial hypertension (IPAH), associated forms of the disease (APAH) and chronic thromboembolic pulmonary hypertension (CTEPH). Methods and Materials: Evaluated according to international guidelines, 94 consecutively referred patients (66 women; mean age 47⫾15 years; median NYHA class III) with IPAH (n⫽29), various forms of APAH (connective tissue disease, HIV infection, congenital shunts; n⫽42) and CTEPH (n⫽23) were included. After initiation of treatment, patients were followed for a mean of 34 (range: 3-88) months. Electrochemiluminescence immunoassays were used to assess serum levels of NT-proBNP and TnT. Results: Baseline NT-proBNP was 284⫾269 pmol/L, while serum levels of TnT were detectable (ⱖ0.01g/L) in 12 (13%) patients (0.042⫾0.020 g/L). During follow-up, 35 (37%) patients either died of cardiopulmonary causes or underwent lung transplantation (n⫽3). In multivariate analysis, baseline serum NT-proBNP and TnT status were both independent predictors of death or transplantation, while their combined analysis further improved their predictive value, with HR 5.7 (95% CI: 1.6-8.7, p⫽0.004) for patients TnT⫹ and with serum NT-proBNP⬎180 pmol/L. For patients with both risk factors present, survival/freedom from transplantation was poor (10%), with 100% survival for patients with none of these present and intermediate results for those with one rsik factor. Conclusions: The combined use of biomarkers assessing ventricular wall stress (NT-proBNP) and myocardial injury (TnT) improves risk stratification in patients with precapillary pulmonary hypertension compared to the independent prognostic information given by either one alone. 530 Endothelin-1 (ET-1) Serum Levels: Relation to Hemodynamics and Clinical Variables in Patients with Pulmonary Vascular Disease N. Selimovic1, B. Andersson1, C.-H. Bergh1, E. Sakiniene2, H. Carlsten2, B. Rundqvist1 1Sahlgrenska University Hospital, Gothenburg, Sweden; 2Sahlgrenska University Hospital, Gothenburg, Sweden Purpose: The purpose of this study was to evaluate predictors of ET-1 levels in patients with pulmonary arterial hypertension (PAH). Methods and Materials: Arterial and pulmonary arterial ET-1 serum concentrations were measured in 39 patients with PAH, age 53⫾17 years (mean ⫾ SD), [idiopathic PAH, n⫽14; PAH associated with collagen vascular disease, n⫽15; other PAH, n⫽2 and chronic thromboembolic pulmonary hypertension (CTEPH), n⫽5] using an enzyme immunoassay technique. Patients underwent right heart catheterization, assessment of NYHA functional class, 6-minute walk test (6MWT) and routine blood tests. Results: Patient characteristics; RAP 7⫾6 mm Hg; mPAP 48⫾17 mm Hg; PVR 9.6⫾5.5 WU; 6-MWT distance 326⫾152 m, NYHA class I/II/III/IV (2/2/32/3) and serum ET-1 levels (3.9⫾1.3pg/ml). We found significant correlations between serum levels of ET-1, hemodynamic data and clinical variables. In multiple regressions model,
The Journal of Heart and Lung Transplantation February 2009
including RAP, mPAP, PVR, age, BMI, 6MWT, s-NT proBNP and serum creatinine (sCr),only sCr and PVR made significant contribution to the prediction of ET-1 levels (p⫽0,001 respectively 0.009).This model explains 62% of the variance in ET-1 levels. Conclusions: ET-1 serum levels correlated with hemodynamic and clinical markers of PAH severity. Serum creatinine and PVR were the most significant contributors in prediction of ET-1 levels. ET-1 bivariate correlation Correlations RAP mPAP CI PVR 6 MWD s-Creatinine NYHA classs
Radial
artery
Pulmonary
artery
r 0.56 0.39 -0.55 0.53 -0.29 0.41 0.36
p-value ⬍0.001 0.013 ⬍0.001 ⬍0.001 0.08 0.009 0.025
r 0.62 0.42 -0.60 0.56 -0.27 0.39 0.36
p-value ⬍0.001 0.008 ⬍0.001 ⬍0.001 0.10 0.014 0.024
Abbreviations: RAP-Right atrial pressure; mPAP - Mean pulmonary artery pressure; PVR-Pulmonary vascular resistance; CI- Cardiac index
531 Brain Natriuretic Peptide Levels: The Canary in the Right Ventricular Mine in Pulmonary Arterial Hypertension R.P. Frantz1, P.R. Julsrud2, C.G.A. McGregor1 1College of Medicine, Mayo Clinic, Rochester, MN; 2College of Medicine, Mayo Clinic, Rochester, MN; 3College of Medicine, Mayo Clinic, Rochester, MN Purpose: Right ventricular failure is an ominous development in patients with pulmonary arterial hypertension (PAH). Cardiac CT and MRI can accurately assess right ventricular volumes and function, but are expensive and not universally available. Brain natriuretic peptide is released from the failing right heart in PAH, and is readily measured. We hypothesized that BNP levels would correlate with right ventricular volumes in PAH. Methods and Materials: Patients with WHO Group I PAH (n⫽17)underwent serial cardiac CT or MRI and measurements of plasma BNP. The BNP levels (natural log transformed due to skewed distribution) were plotted against right ventricular end-diastolic volume (RVEDV). Results: Extent of elevation in BNP correlated with extent of RV enlargement, with a logarithmic plot best fitting the data (correlation coefficient 0.70). A BNP level of ⬎ 150 pg/ml provided 100% specificity and 88% sensitivity for presence of an RVEDV ⬎ 200 ml. In individual patients, serial changes in BNP levels correlated with changes in RVEDV. Conclusions: BNP levels correlate with extent of right ventricular enlargement as measured by CT or MRI. BNP levels ⬎ 150 pg/ml appear to be a useful marker for RVEDV ⬎ 200 ml. Changes in BNP correlate with changes in RVEDV in individual patients and accordingly may be a useful way to follow patients with regard to status of the right ventricle.
Abstracts
529 Simultaneous Measurement of Serum N-Terminal Brain Natriuretic Peptide and Troponin T in Risk Assessment of Pateints with Precapillary Pulmonary Hypertension A.K. Andreassen1, S. Arora1, E. Gude1, O.G. Solberg1, R. Wergeland2 1Rikshospitalet University Hospital, Oslo, Norway; 2 Rikshospitalet Univeristy Hospital, Oslo, Norway Purpose: While various markers of disease severity have been applied in risk assessement in patients with precapillary pulmonary hypertension, limited data exists on the simultaneous application of two biomarkers. We evaluated the prognostic value of combined use of serum levels of TnT and NT-proBNP in a group of patients with idopathic pulmonary arterial hypertension (IPAH), associated forms of the disease (APAH) and chronic thromboembolic pulmonary hypertension (CTEPH). Methods and Materials: Evaluated according to international guidelines, 94 consecutively referred patients (66 women; mean age 47⫾15 years; median NYHA class III) with IPAH (n⫽29), various forms of APAH (connective tissue disease, HIV infection, congenital shunts; n⫽42) and CTEPH (n⫽23) were included. After initiation of treatment, patients were followed for a mean of 34 (range: 3-88) months. Electrochemiluminescence immunoassays were used to assess serum levels of NT-proBNP and TnT. Results: Baseline NT-proBNP was 284⫾269 pmol/L, while serum levels of TnT were detectable (ⱖ0.01g/L) in 12 (13%) patients (0.042⫾0.020 g/L). During follow-up, 35 (37%) patients either died of cardiopulmonary causes or underwent lung transplantation (n⫽3). In multivariate analysis, baseline serum NT-proBNP and TnT status were both independent predictors of death or transplantation, while their combined analysis further improved their predictive value, with HR 5.7 (95% CI: 1.6-8.7, p⫽0.004) for patients TnT⫹ and with serum NT-proBNP⬎180 pmol/L. For patients with both risk factors present, survival/freedom from transplantation was poor (10%), with 100% survival for patients with none of these present and intermediate results for those with one rsik factor. Conclusions: The combined use of biomarkers assessing ventricular wall stress (NT-proBNP) and myocardial injury (TnT) improves risk stratification in patients with precapillary pulmonary hypertension compared to the independent prognostic information given by either one alone. 530 Endothelin-1 (ET-1) Serum Levels: Relation to Hemodynamics and Clinical Variables in Patients with Pulmonary Vascular Disease N. Selimovic1, B. Andersson1, C.-H. Bergh1, E. Sakiniene2, H. Carlsten2, B. Rundqvist1 1Sahlgrenska University Hospital, Gothenburg, Sweden; 2Sahlgrenska University Hospital, Gothenburg, Sweden Purpose: The purpose of this study was to evaluate predictors of ET-1 levels in patients with pulmonary arterial hypertension (PAH). Methods and Materials: Arterial and pulmonary arterial ET-1 serum concentrations were measured in 39 patients with PAH, age 53⫾17 years (mean ⫾ SD), [idiopathic PAH, n⫽14; PAH associated with collagen vascular disease, n⫽15; other PAH, n⫽2 and chronic thromboembolic pulmonary hypertension (CTEPH), n⫽5] using an enzyme immunoassay technique. Patients underwent right heart catheterization, assessment of NYHA functional class, 6-minute walk test (6MWT) and routine blood tests. Results: Patient characteristics; RAP 7⫾6 mm Hg; mPAP 48⫾17 mm Hg; PVR 9.6⫾5.5 WU; 6-MWT distance 326⫾152 m, NYHA class I/II/III/IV (2/2/32/3) and serum ET-1 levels (3.9⫾1.3pg/ml). We found significant correlations between serum levels of ET-1, hemodynamic data and clinical variables. In multiple regressions model,
The Journal of Heart and Lung Transplantation February 2009
including RAP, mPAP, PVR, age, BMI, 6MWT, s-NT proBNP and serum creatinine (sCr),only sCr and PVR made significant contribution to the prediction of ET-1 levels (p⫽0,001 respectively 0.009).This model explains 62% of the variance in ET-1 levels. Conclusions: ET-1 serum levels correlated with hemodynamic and clinical markers of PAH severity. Serum creatinine and PVR were the most significant contributors in prediction of ET-1 levels. ET-1 bivariate correlation Correlations RAP mPAP CI PVR 6 MWD s-Creatinine NYHA classs
Radial
artery
Pulmonary
artery
r 0.56 0.39 -0.55 0.53 -0.29 0.41 0.36
p-value ⬍0.001 0.013 ⬍0.001 ⬍0.001 0.08 0.009 0.025
r 0.62 0.42 -0.60 0.56 -0.27 0.39 0.36
p-value ⬍0.001 0.008 ⬍0.001 ⬍0.001 0.10 0.014 0.024
Abbreviations: RAP-Right atrial pressure; mPAP - Mean pulmonary artery pressure; PVR-Pulmonary vascular resistance; CI- Cardiac index
531 Brain Natriuretic Peptide Levels: The Canary in the Right Ventricular Mine in Pulmonary Arterial Hypertension R.P. Frantz1, P.R. Julsrud2, C.G.A. McGregor1 1College of Medicine, Mayo Clinic, Rochester, MN; 2College of Medicine, Mayo Clinic, Rochester, MN; 3College of Medicine, Mayo Clinic, Rochester, MN Purpose: Right ventricular failure is an ominous development in patients with pulmonary arterial hypertension (PAH). Cardiac CT and MRI can accurately assess right ventricular volumes and function, but are expensive and not universally available. Brain natriuretic peptide is released from the failing right heart in PAH, and is readily measured. We hypothesized that BNP levels would correlate with right ventricular volumes in PAH. Methods and Materials: Patients with WHO Group I PAH (n⫽17)underwent serial cardiac CT or MRI and measurements of plasma BNP. The BNP levels (natural log transformed due to skewed distribution) were plotted against right ventricular end-diastolic volume (RVEDV). Results: Extent of elevation in BNP correlated with extent of RV enlargement, with a logarithmic plot best fitting the data (correlation coefficient 0.70). A BNP level of ⬎ 150 pg/ml provided 100% specificity and 88% sensitivity for presence of an RVEDV ⬎ 200 ml. In individual patients, serial changes in BNP levels correlated with changes in RVEDV. Conclusions: BNP levels correlate with extent of right ventricular enlargement as measured by CT or MRI. BNP levels ⬎ 150 pg/ml appear to be a useful marker for RVEDV ⬎ 200 ml. Changes in BNP correlate with changes in RVEDV in individual patients and accordingly may be a useful way to follow patients with regard to status of the right ventricle.