704-2 Comparative Relation of Neurohormonal Activation to Hemodynamics in Primary or Precapillary Secondary Pulmonary Hypertension

Abstract

Primary (PPH) or precapillary secondary (SPH) pulmonary hypertension show similar hemodynamic abnormalities and an intense neurohormonal activation has been detected in both syndromes. Comparative analysis of the neurohormonal profile and its relation to hemodynamics of patients with PPH and SPH are not available. Plasma levels of atrial natriuretic peptide (ANP). aldosterone (ALD). renin activity (PRA). epinephrine (PE). norepinephrine (PNE) and endothelin (ET) were assessed from the antecubital vein in 12 patients with PPH and 7 patients with SPH (2 connective tissue disease, 2 chronic thromboembolic, 3 closed atrial septal defect). Hemodynamics were measured by heart catheterization. Between PPH and SPH patients no differences were assessed on cardiac index (CI) (2.2 ± 0.2 vs 2.3 ± 03 l/min/m 2 , ns), mean pulmonary artery pressure (PAP) (55 ± 12 vs 58 ± 12 mmHg, ns), pulmonary vascular resistance (PVR) (14 ± 6 vs 14 ± 4 RU, ns) right atrial pressure (RAP) (4 ± 4 vs 8 ± 7 mmHg, p = 0.13) and mixed venous blood oxygen saturation (vSat) (62 ± 7 vs 65 ± 9%, ns). Neurohormonal parameters in patients with PPH and patients with SPH were as follows ANP (pg/ml) ALD (pg/mi) PRA (ng/ml/h) PE (pg/ml) PNE (pg/ml) ET (pg/ml) PPH 203 ± 139 178 ± 132 1.8 ± 2.1 351 ± 420 426 ± 343 4.5 ± 3.1 SPH 210 ± 110 220 ± 262 2.5 ± 4.0 268 ± 333 637 ± 720 6.9 ± 3.7 p ns ns ns ns ns ns In patients with PPH, ET was correlated to RAP (r = 0.68, p < 0.02), to CI (r = 0.66, P < 0.02) and to PVR (r = 0.65, p < 0.02). In patients with SPH, ET was correlated to RAP (r = 0.96, P < 0.01), PNE was correlated to vSat (r = -0.80, P < 0.03) and ALD was correlated to RAP (r = 0.87, p < 0.02) No differences were observed on plasma levels of neurohormons between patients with PPH and SPH. In patients with PPH hemodynamic abnormalities were correlated only to ET plasma levels while in patients with SPH hemodynamics were correlated to ET, to PNE and to ALD plasma levels. Neuroendocrine activation shows a different pattern of association with hemodynamic abnormalities in patients with PPH compared to patients with SPH