AB

ST

RA

CT

S

S286 Heart, Lung and CirculationAbstracts 2009;18S:S1–S286

lites downstream of kynurenine had no material effect onvessel relaxation.

Conclusion: This study suggests that tryptophanmetabolism to kynurenine may contribute to the regu-lation of vascular tone in atherosclerosis, opening thepossibility for novel treatments of ischemic complicationsarising from atherosclerosis.

doi:10.1016/j.hlc.2009.05.701

656VASCULAR DEATH IN RURAL ANDHRA PRADESH,INDIA

S. Gandham, R. Dandona, R. Joshi

The George Institute for International Health, Sydney, NSW,Australia

Background: Mortality from cardiovascular disease isgradually increasing throughout India. However, accurateand reliable data about fatal cardiovascular disease arefew, especially for rural India. This abstract aims to estab-lish the proportion of deaths attributable to cardiovascularcauses in rural Andhra Pradesh to inform the need forpreventive interventions.

Methods: Mortality data were obtained from a verbalautopsy based mortality surveillance system during a 3-year period in 2003-2006 from 45 villages in the Godavariregion of Andhra Pradesh. Verbal autopsies were reviewedby trained physicians and a cause of death was recordedaccording to the ICD-10. The main causes of death wereestablished and vascular causes of death were further ana-lyzed.

Results: Between the 1st of October 2003 and 30th ofSeptember 2006, 4375 deaths were identified and verbalautopsies were completed for 98% of all deaths. Diseasesof the circulatory system was the leading cause of deathresponsible for 37% of all deaths: ischaemic heart disease(43%), cerebrovascular disease (31%) and the remain-der hypertensive disease, heart failure, rheumatic heartdisease and other forms of vascular disease (26%). Vascu-lar diseases were responsible for a greater proportion ofdeaths among men than women and about one-quarter ofvascular deaths occurred below the age of 60. Of all cardio-vascular deaths, 47% were known hypertensives and 18%were known diabetics.

Conclusions: Cardiovascular disease is a large healthproblem in this developing rural region of India. Pol-icy makers need to reorient healthcare infrastructure toaccommodate the growing need for cardiovascular diseaseprevention and management.

doi:10.1016/j.hlc.2009.05.702

657SCREENING AND TREATING PULMONARY HYPER-TENSION IN A MULTIDISCIPLINARY CLINIC—THEFIRST 198 PATIENTS

A.J. Low, D. Fowler, M.K. Manghani, P. Youssef, I. Young,R. Garsia, P. Torzillo, D.S. Celermajer

Departments of Cardiology, Rheumatology, RespiratoryMedicine and Immunology, Royal Prince Alfred Hospital,Sydney NSW 2050, Australia

Background: Pulmonary arterial hypertension (PAH) isan increasingly recognised serious illness with insidiousonset, often delayed diagnosis, complex diagnostic algo-rithms and poor prognosis, but with recently availableeffective treatments. In order to efficiently diagnose andoffer treatment in PAH, we established a multidisciplinaryservice in 2005, where patients attend a clinic staffed byspecialists in cardiology, respiratory medicine, rheumatol-ogy and immunology in a tertiary referral hospital setting.

Methods: We studied the first 198 patients referred.Serology, echocardiography, lung function tests, highresolution computerised tomography, WHO Class deter-mination and 6-min walk tests and/or right heart study(RHS) were performed as indicated. Follow up and out-comes were recorded.

Results: Of 198 patients seen, 66 had pulmonaryhypertension (mean PAP > 25 mmHg) diagnosed onecho ± RHS of whom 60 had catheter-proven PAH (meanPAP > 25 mmHg with mean wedge pressure < 18 mmHg).Underlying diagnoses for the PAH patients were idio-pathic (34), scleroderma-associated (14), other connectivetissue disease (4), and those associated with congenitalheart disease (8). Of these 60, 57 were commenced onPAH-specific therapy—initially Bosentan in the majoritybut Sitaxentan, Iloprost and Sildenafil were occasion-ally used for patient-specific reasons. Seven patientsare on dual PAH therapy, 11 have died despitetreatment and one has undergone heart-lung trans-plantation. All other patients with PAH have attendedfor 6-monthly follow-up visits with a 100% retentionrate.

Conclusion: A multidisciplinary clinic can provide effi-cient diagnosis and rapid triage to PAH-specific therapy,if appropriate. Follow-up rates are high, up to 4 years.

doi:10.1016/j.hlc.2009.05.703