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164 J KARDIOL 2008; 15 (5–6)

ÖKG-Jahrestagung – Abstracts

pacemakers (odds ratio [OR] and 95 %-CI 76.40 [7.67–10351];

p < 0.001), splenectomy (OR 17.87 [1.56–2438]; p = 0.17), previ-

ous venous thromboembolism (VTE) (OR 4.52 [2.35-9.12],

p < 0.001), recurrent VTE (OR 14.49 [5.40-43.08], p < 0.001),

blood groups non-0 (OR (OR 2.09 [1.12–3.94]; p = 0.019), and

lupus anticoagulant/anti-phospholipid antibodies (OR 4.20 [1.56–

12.21]; p = 0.004) have an increased risk for CTEPH. Thyroid re-

placement therapy (OR 6.10 [2.73–15.05]; p < 0.001) and a history

of malignancy (OR 3.76 [1.47–10.43]; p = 0.005) emerged as novel

CTEPH risk factors.

Conclusions This European database confirmed previous know-

ledge on CTEPH risk factors, and identified thyroid replacement

therapy and a history of malignancy as new medical conditions as-

sociated with CTEPH.

NT-proBNP Early After Acute Myocardial Infarction:

Relation to Infarct Size, Myocardial Function and

Serial CK-MB/cTnT Measurements 062

A. Mayr, G. Klug, K. Pedarnig, M. Nowosielski, A. Köhler, T. Trieb, M. Schocke,

O. Pachinger, B. Metzler

Abteilung für Kardiologie, Abteilung für Radiologie 1; Medizinische Universität

Innsbruck

Background The aim of the present study was to correlate N-ter-

minal brain natriuretic peptide (NT-proBNP) concentrations deter-

mined 48 and 72 hours after admission for acute myocardial infarc-

tion to infarct size and functional parameters determined by cardiac

magnetic resonance (CMR) imaging. Furthermore we compared the

results to those obtained with serial creatine-kinase (CK) and car-

diac Troponin T (cTnT) measurements.

Methods Therefore we performed CMR in 37 consecutive pa-

tients (32 male) within 1 to 6 days after first acute myocardial infarc-

tion and primary angioplasty. Infarct size was determined as percent

of LV tissue on delayed Gadolinium enhanced phase-sensitive IR-

SSFP sequences. End-diastolic (EDV) and end-systolic (ESV) vol-

ume as well as ejection fraction (EF) and myocardial mass (MM)

were obtained from short-axis cine-MR sequences. Blood was rou-

tinely drawn 24, 48 and 72 hours after admission. CK-MB and cTnT

values were determined after 23 ± 4, 46 ± 6 and 68 ± 6 hours. NT-

pro BNP was determined after 45 ± 10 and 69 ± 6 hours. Mean and

maximum values were determined for all laboratory measures.

Results NT-proBNP values significantly correlate positively with

infarct size. The strongest correlation was observed if blood was

drawn early (r: 0.522 at 48 hours vs r: 0.431 at 72 hours; all

p < 0.02). Further NT-proBNP values at 48 hours were inversely

correlated with EF and positively with ESV (r: –0.427 and r: 0.349;

all p < 0.05) but not with EDV and MM (all p > 0.05). Mean and

maximum values seemed not to be superior to measurements at

48 hours. NT-proBNP levels at both timepoints were significantly

correlated with CK and cTnT values (all p < 0.01). Mean and maxi-

mum CK and cTnT values showed the highest correlation to infarct

size (r: 0.610 to 0.706; all p < 0.001).

Conclusion NT-proBNP values determined 48 hours after admis-

sion may provide a useful tool in the estimation of infarct size and

myocardial functional with similar performance than CK or cTnT

determination.

NT-proBNP has a High Negative Predictive Value

to Rule-Out Short-Term Cardiovascular Events in

Patients with Diabetes Mellitus 043

S. Neuhold, M. Huelsmann, G. Strunk, A. Luger, M. Riedl, R. Pacher, G. Gouya,

A. Hammer, M. Elhenicky, M. Clodi

Department of Internal Medicine II; Department of Internal Medicine III, Medical

University of Vienna

Purpose Although it is widely recognized that the absolute risk of

cardiovascular events varies among individuals with diabetes melli-

tus there is a lack of reliable short-term predictors to guide timely

and individualized management. This study evaluated the predic-

tive value of NT-proBNP for patients with diabetes and compared

the prognostic aptitude of this neurohumoral marker to traditional

intermediate and long-term markers of cardiovascular events.

Methods A prospective observational study in 631 patients with

diabetes mellitus. The composite endpoint consisted of unplanned

cardiovascular hospitalization and death within the observation pe-

riod of 9.1 ± 4. 7 months.

Results NT-proBNP was significantly associated with an in-

creased risk of reaching the composite endpoint in the entire popu-

lation (p < 0.0001). The association was maintained for patients

without a history of cardiovascular disease (p < 0.0001). Of all vari-

ables analyzed (age, gender, history of hypertension, history of

ischemic heart disease, history of any cardiac disease, NYHA-class,

Dyspnoe Score, Minnesota Living with Heart Failure Question-

naire, history of smoking, duration of diabetes, body mass index,

blood pressure, LDL-cholesterol, HbA1c, blood glucose, serum-

creatinine, glomerular filtration rate, microalbuminuria), NT-

proBNP gave the most potent information in the stepwise logistic

regression model (p < 0.0001, with NYHA-class and glomerular

filtration as additional independent variables) as well as in a step-

wise Cox-regression analysis (p < 0.0001, with duration of diabe-

tes, Dyspnoe Score and glomerular filtration rate as additional inde-

pendent variables).

Conclusions In the present study we have demonstrated a strong

and independent correlation between plasma NT-proBNP levels

and short-term prognosis of cardiovascular events for patients with

diabetes mellitus. With a high negative predictive value it can safely

identify those individuals who are not at intermediate risk for car-

diovascular events.

Furthermore, NT-proBNP, a functional marker of cardiovascular

health, proved to be of higher predictive value than traditional car-

diovascular markers in our study.

Comparison of Copeptin, B-type Natriuretic Peptide,

and Amino-Terminal pro-B-Type Natriuretic Peptide

in Patients with Chronic Heart Failure: Prediction of

Death at Different Stages of the Disease 045

M. Elhenicky, S. Neuhold, M. Huelsmann, G. Strunk, B. Stoiser, J. Struck,

N. Morgenthaler, A. Bergmann, G. Gouya, A. Hammer, R. Pacher

Division of Cardiology, Department of Internal Medicine II, Medical University of

Vienna; Vienna University of Economics and Business Administration; BRAHMS

AG Hennigdorf

Purpose Vasopressin has demonstrated to be increasing with the

severity of chronic heart failure. Copeptin is a fragment of pre-pro-

vasopressin, which is being synthesized and secreted in equimolar

amounts to vasopressin. Both hormones have a short life time in

vivo – similar to b-type natriuretic peptides – but in contrast to

Vasopressin, Copeptin is very stable in vitro. The predictive value

of Copeptin has been shown in advanced heart failure, where it was

superior to BNP to predict 24-month mortality. Our aim was to

evaluate the predictive value of Copeptin over the entire spectrum

of heart failure (HF), and compare it to the current benchmark mark-

ers, BNP and NT-proBNP.

Methods Long-term observational study in 786 HF patients from

the whole spectrum of heart failure (NYHA I–IV, BNP 688 ±

948 pg/ml [range 3–8536 pg/ml] LVEF 25 ± 10 % [range 5–65 %]).

Results NYHA-class was the most potent single predictor of

24-month outcome in a stepwise Cox-Regression model. BNP,

Copeptin and glomerular filtration rate were related to NYHA-class

(for trend p < 0.0001). Copeptin was the most potent single predic-

tor of mortality in patients with NYHA-class II (p < 0.0001) and

NYHA-class III (p < 0.0001). In NYHA-class IV the outcome of

patients was best predicted by serum-sodium, but again, Copeptin

added additional independent information.

Conclusion Increased levels of Copeptin are linked to excess

mortality, and this link is maintained irrespective of the clinical

signs of severity of the disease. Copeptin was superior to BNP or

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