Echocardiographic Predictors of Outcome in Eisenmenger Syndrome
Background—Eisenmenger syndrome differs significantly from other types of pulmonary arterial hypertension in its physiology and prognosis. We aimed to assess the relationship between the echocardiographic characteristics of patients with Eisenmenger syndrome and mortality.
Methods and Results—Clinical and echocardiographic variables were assessed in 181 consecutive patients with Eisenmenger syndrome, excluding those with complex congenital heart disease. Patients' mean age was 39.1±12.8 years, 59 (32.6%) were male, 122 (67.4%) were in functional class III or higher and 74 (40.9%) were on advanced therapies. Mean oxygen saturation at rest was 85.1±7.8% whereas median BNP was 55.4ng/L. Over a median follow-up of 16.4 months, 19 patients died; the strongest predictors of mortality were tricuspid annular plane systolic excursion (TAPSE) and peak systolic velocity, myocardial performance (expressed as total isovolumic time and systolic to diastolic duration ratio) and elevated central venous pressure (expressed as right atrial (RA) area, RA pressure and RA to left atrial area ratio), even after accounting for advanced therapies. A composite score based on the strongest echocardiographic predictors of outcome including one point for each of the following: TAPSE<15mm, right ventricular (RV) effective systolic to diastolic duration ratio ≥1.5, RA area ≥25cm2, RA/LA area ratio≥1.5 was highly predictive of clinical outcome (AUC 0.90±0.01), with no improvement when BNP and resting saturations were added in the model.
Conclusions—Echocardiographic parameters of RV function and RA area predict mortality in Eisenmenger patients. A new composite echocardiographic score, described herewith, may be incorporated in the non-invasive, periodic assessment of these patients.
- Received January 5, 2012.
- Accepted August 2, 2012.
- Copyright © 2012, American Heart Association, Inc. All rights reserved. Unauthorized use prohibited