Poster Display II. Natriuretic peptides Sunday, 10 June 2007 13 67 Pulmonary artery systolic pressure is an independent predictor of N-terminal pro-B-type natriuretic peptide in systolic heart failure J. Silva Marques 1 , C. David 2 , A.G. Almeida 2 , M.G. Lopes 2 1 Lisbon Medical Faculty, Cardiology, Lisbon, Portugal; 2 Santa Maria Hospital, Cardiology, Lisbon, Portugal Purpose: NT-pro B-type natriuretic peptide (NT-proBNP) has predomi- nantly ventricular origin, produced and released in response to increases in ventricular wall stress. It has been related both to systolic and dias- tolic left ventricular (LV) dysfunction. The purpose of this study was to investigate the correlations of NT-proBNP levels with echocardiographic measurements in patients with systolic heart failure. Methods: We prospectively investigated patients with symptoms/signs of CHF class II-IV and LV biplane ejection fraction (EF)<45%. Af- ter clinical evaluation an echocardiogram was done including M mode, 2D (ventricular dimensions and LV ejection fraction (EF)), conven- tional Doppler (LV inflow E wave, pulmonary artery systolic pressure (PASP), LV dP/dT). Early and late peak systolic myocardial velocity (Sm1 and Sm2), velocity time integral of Sm(SmVTI), early(Em) and late (Am) peak diastolic myocardial velocities were assessed by pulsed tissue Doppler of septal and lateral mitral annulus and tricuspid annulus. Blood was collected for NT-proBNP measurement. Results: Twenty patients were included 85% male, 71±9,5 years. Mean LV EF was 30±8%, dP/dT 557±164mmHg/s, NT-proBNP 7052±6314pg/mL. There was a trend toward higher NT-proBNP levels in those patients with lower inferior vena cava (IVC) colapse index (p=0,09) and a nonsignificant higher expiratory IVC diameter (p=0,15). Right ven- tricular end-diastolic dimension by 2D planimetry of four-chamber api- cal view showed a significant direct correlation to NT-pro-BNP levels (r 2 =0,24; p=0,03) as did PSAP (r 2 =0,37; p=0,009). No significant corre- lation was found with tissue Doppler measurements of tricuspid annulus. There was a trend to lower mitral E-wave deceleration time (r2=0,15; p=0,09) in patients with higher NT-pro BNP. No correlation was found to dP/dT and there was a nonsignificant trend to lower LV EF (p=0,07) in those with higher natriuretic peptides. Sm VTI of septal mitral an- nulus inversely correlated to NT-proBNP (r2=0,20; p=0,049). No other tissue Doppler measurements showed a signicant relation. PSAP was the only independent predictor of NT-proBNP in multiple regression analysis (p=0,029). Conclusion: NT-proBNP level relates to right ventricular dimention and PSAP in systolic heart failure patients. This relation sugests that right ventricular secretion of NT-proBNP may be an important contributor to serum levels of this natriuretic peptide in patients with systolic heart failure. Septal mitral annulus Sm VTI may be a more accurate estimate of global systolic function since it may be under influence of both the right and left ventricle. 68 Extent of myocardial scar: Does it affect improvement of neurohormonal activation after levosimendan infusion? A.N. Kitsiou, P. Kelepouris, A. Anadiotis, S. Karas Sismanoglio Hospital, Cardiology Department, Athens, Greece Background: Heart failure is characterized by neurohormonal activa- tion that can be assessed with measurements of plasma brain natriuretic peptide (BNP). The purpose of this study was to assess changes in BNP levels after intravenous administration of levosimendan and their associ- ation with the extent of myocardial scar. Methods: We studied 14 patients (12 men, mean age 67.9±8.5 years) with a history of old myocardial infarction, left ventricular (LV) dysfunc- tion and NYHA class III-IV heart failure on admission, who were not candidates for revascularization. The extent of myocardial scar was mea- sured by Thallium-201 SPECT (17-segment model). BNP levels and left ventricular ejection fraction (LVEF), using echocardiography, were mea- sured before, and 20-24 hours after the termination of a 24h intravenous levosimendan infusion (0.1μg/kg/min). Results: Clinical improvement was observed in all patients after levosi- mendan infusion. Mean LVEF increased from 27.4±4.3 to 29.1±4.7 after levosimendan (p<0.05) and BNP levels decreased from 1001.4±233.3 to 543.7±181 (p<0.001). The %increase of LVEF did not differ sig- nificantly in patients with ≤6 scarred myocardial segments compared to patients with 7-8 scarred myocardial segments (+0.92±0.04% VS +0.97±0.08%, p=NS). In contrast, the %decrease of BNP levels was significantly different between the two patient groups (-46± 0.07% VS -0.65±0.05%, p<0.001). Conclusion: After levosimendan infusion, the decrease in neurohor- monal activation, as assessed by BNP levels, was inversely associated with the extent of myocardial scar in heart failure patients with a history of old myocardial infarction and LV dysfunction. 69 Utility of NT-proBNP as a screening tool for ventricular dysfunction and hypertrophy in patients with long standing Diabetes Mellitus P. Reddy 1 , L.L. Tin 2 , P.H. Loh 1 , G. Mathur 1 , A.S. Rigby 1 , K.M. Goode 1 , A.L. Clark 1 , J.G.F. Cleland 1 on behalf of Academic Cardiology, University of Hull 1 University of Hull, Academic Cardiology, Cottingham, United Kingdom; 2 The University of Hull, Academic Cardiology, Hull, United Kingdom Background: Patients with long standing diabetes mellitus (DM) are more likely to have left ventricular hypertrophy or dysfunction. Iden- tification of such complications may influence treatment and outcome. NT-proBNP may be a simple and effective screening tool. Aims: To determine the prevalence of major cardiac dysfunction in pa- tients with long standing diabetes compared to controls. Methods: Out-patients with long standing diabetes aged > 50 years and age and sex matched controls were recruited. Standard clinical history was recorded. Physical examination, ECG, ECHO and blood tests for NT-proBNP and biochemical profile were done. Systolic function was measured by modified Simpson’s and diastolic function by transmitral and aortic flow Doppler. LV mass index (LVMI) by Devereux’s modified ASE Cube formula, was increased if > 71g/m 2.7 (95th centile of the control group). Relative wall thickness (RWT) (2×PWTd/LVIDd) was increased when RWT> 0.61 (95th centile of the control group). Patients were assigned as follows: Group 1 – Normal LVMI and RWT; Group 2 – Concentric remodelling-Normal LVMI and RWT>0.61; Group 3 – Eccentric LVH- Increased LVMI and RWT<0.61; Group 4 – Concentric LVH- Increased LVMI and RWT > 0.61. Group 5: LVSD Results: 215 patients were identified. 160 consented. Patients with renal dysfunction were excluded. 108 patients were matched for age and sex with 108 controls. The median age was 64yrs and 35% were women. Results: Median systolic BP was 148 mm Hg and serum creatinine was 97 μmol/L. 51% had cardiac remodelling (group 2, 3 or 4) compared to 29% of the control group. In the DM group, 8 patients had systolic dys- function (LVSD) and 50 diastolic dysfunction (DD) compared to 0 with LVSD and 32 with DD of the controls. In the DM group, the median NT- proBNP in patients with Group 1 was 8pmol/L [n=45], 9pmol/L in Group 2 (concentric remodelling) [n=29], 19pmol/L in Group3 (eccentric LVH) [n=15], 36pmol/L in Group 4 (concentric LVH) [n=11] and 64pmol/L in Group 5 (LVSD) [n=8] (p<0.001 across groups). Multivariable analy- sis including LVMI, RWT, diastolic function, pattern of remodelling and LVSD showed the pattern of remodelling and LVSD were best correlated with NT-proBNP levels (correlation coefficient 0.370, p<0.001). Conclusion: There is a high prevalence of cardiac remodelling and LVSD in patients with long standing DM. NT-proBNP is elevated in patients with eccentric remodelling, concentric LVH and LVSD. The pattern of remodelling and presence of LVSD seems to have the greatest influence on NT-proBNP levels.