(757) - Hemodynamic Correlates and Prognostic Implication of Vasodilator Response in Reactive Pulmonary Hypertension Due To Left Heart Disease (PHLHD)

Abstract

To study the hemodynamic correlates and prognostic implication of response to sodium nitroprusside (SNP) infusion. We included 64 consecutive patients with confirmed reactive PHLHD on catheterisation who were hospitalized for management of advanced heart failure (HF). SNP infusion was titrated to achieve a PVR reduction of >20%. SNP was stopped if mean blood pressure 20% with an unchanged/increased stroke volume. Endpoint was a composite of death, transplantation or ventricular assist device (VAD) as bridge to transplantation. Of the 64 patients [TABLE], 34 patients responded to SNP. Percentage change in PVR (r=-0.390) and pulmonary capacitance (r=-0.527) correlated with baseline PVR/systemic vascular resistance (SVR) ratio (both p<0.01). SNP infusion improved pulmonary hemodynamics [TABLE], lowered PVR/SVR ratio and resulted in greater increase in pulmonary capacitance (41% (27-52) vs 16% (9-27), p<0.01) in responders compared to non-responders. PVR/SVR ratio was independently associated with SNP response on multivariate analysis (p<0.01). Response to SNP was associated with lower composite endpoints - 8/34 vs 16/28 endpoints in responders and non-responders respectively [FIGURE] (p<0.01 on Log-rank test) over a median follow-up of 230 (71-421) days. Baseline PVR/SVR ratio is associated with response to SNP. Patients with reactive PHLHD responsive to SNP have a more favourable prognosis.TableResponders (n=34)Non-responders (n=28)pAge (years)50 (5)50 (3)0.946Males (n, %)28 (82)18 (68)0.185Severe MR (n, %)12 (36)14 (50)0.252LVEF (%)18 (3)26 (7)0.026LVESVi (ml/m2)55.9 (5.6)71.5 (20)0.090TAPSE (mm)12.7 (1.1)13.1 (1.7)0.618Peak VO2 (ml/kg/min)10.5 (1.1)10.2 (1.1)0.827stroke volume (ml)43.3 (4.2)48.6 (6.5)0.152stroke volume post-SNP51.7 (4.6)53.7 (6.5)0.598PVR (dyne.s/cm5)382 (53)498 (164)0.141PVR post-SNP232 (34)437 (161)0.007SVR (dyne.s/cm5)1842 (181)1631 (202)0.119SVR post-SNP1288 (75)1239 (155)0.548PVR/SVR ratio0.21 (0.02)0.28 (0.05)0.002PVR/SVR post-SNP0.18 (0.02)0.32 (0.07)<0.001 Open table in a new tab