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Moceri P, Dimopoulos K, Liodakis E, Germanakis I, Kempny A, Diller GP, Swan L, Wort SJ, Marino PS, Gatzoulis MA, Li W. Echocardiographic Predictors of Outcome in Eisenmenger Syndrome. Circulation 2012; 126:1461-8. [DOI: 10.1161/circulationaha.112.091421] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Eisenmenger syndrome differs significantly from other types of pulmonary arterial hypertension in its physiology and prognosis. We sought 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%, and median B-type natriuretic peptide was 55.4 ng/L. Over a median follow-up of 16.4 months, 19 patients died; the strongest predictors of mortality were tricuspid annular plane systolic excursion and peak systolic velocity, myocardial performance (expressed as total isovolumic time and ratio of systolic to diastolic duration), and elevated central venous pressure (expressed as right atrial [RA] area, RA pressure, and ratio of RA to left atrial area), even after we accounted for advanced therapies. A composite score based on the strongest echocardiographic predictors of outcome, including 1 point for each of the following: tricuspid annular plane systolic excursion <15 mm, ratio of right ventricular effective systolic to diastolic duration ≥1.5, RA area ≥25 cm
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, ratio of RA to left atrial area ≥1.5, was highly predictive of clinical outcome (area under the curve 0.90±0.01), with no improvement when B-type natriuretic peptide and resting saturations were added into the model.
Conclusions—
Echocardiographic parameters of right ventricular function and RA area predict mortality in Eisenmenger patients. A new composite echocardiographic score, described herewith, may be incorporated into the noninvasive, periodic assessment of these patients.
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Affiliation(s)
- Pamela Moceri
- From the Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom (P.M., K.D., E.L., I.G., A.K., G.D., L.S., S.J.W., P.S.M., M.A.G., W.L.); Pasteur University Hospital, Nice, France (P.M.); and National Institute for Health Research Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, and National Heart and Lung Institute, Imperial College School of Medicine, London, United Kingdom (K.D., G.D., M.A.G.)
| | - Konstantinos Dimopoulos
- From the Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom (P.M., K.D., E.L., I.G., A.K., G.D., L.S., S.J.W., P.S.M., M.A.G., W.L.); Pasteur University Hospital, Nice, France (P.M.); and National Institute for Health Research Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, and National Heart and Lung Institute, Imperial College School of Medicine, London, United Kingdom (K.D., G.D., M.A.G.)
| | - Emmanouil Liodakis
- From the Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom (P.M., K.D., E.L., I.G., A.K., G.D., L.S., S.J.W., P.S.M., M.A.G., W.L.); Pasteur University Hospital, Nice, France (P.M.); and National Institute for Health Research Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, and National Heart and Lung Institute, Imperial College School of Medicine, London, United Kingdom (K.D., G.D., M.A.G.)
| | - Ioannis Germanakis
- From the Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom (P.M., K.D., E.L., I.G., A.K., G.D., L.S., S.J.W., P.S.M., M.A.G., W.L.); Pasteur University Hospital, Nice, France (P.M.); and National Institute for Health Research Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, and National Heart and Lung Institute, Imperial College School of Medicine, London, United Kingdom (K.D., G.D., M.A.G.)
| | - Aleksander Kempny
- From the Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom (P.M., K.D., E.L., I.G., A.K., G.D., L.S., S.J.W., P.S.M., M.A.G., W.L.); Pasteur University Hospital, Nice, France (P.M.); and National Institute for Health Research Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, and National Heart and Lung Institute, Imperial College School of Medicine, London, United Kingdom (K.D., G.D., M.A.G.)
| | - Gerhard-Paul Diller
- From the Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom (P.M., K.D., E.L., I.G., A.K., G.D., L.S., S.J.W., P.S.M., M.A.G., W.L.); Pasteur University Hospital, Nice, France (P.M.); and National Institute for Health Research Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, and National Heart and Lung Institute, Imperial College School of Medicine, London, United Kingdom (K.D., G.D., M.A.G.)
| | - Lorna Swan
- From the Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom (P.M., K.D., E.L., I.G., A.K., G.D., L.S., S.J.W., P.S.M., M.A.G., W.L.); Pasteur University Hospital, Nice, France (P.M.); and National Institute for Health Research Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, and National Heart and Lung Institute, Imperial College School of Medicine, London, United Kingdom (K.D., G.D., M.A.G.)
| | - Stephen J. Wort
- From the Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom (P.M., K.D., E.L., I.G., A.K., G.D., L.S., S.J.W., P.S.M., M.A.G., W.L.); Pasteur University Hospital, Nice, France (P.M.); and National Institute for Health Research Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, and National Heart and Lung Institute, Imperial College School of Medicine, London, United Kingdom (K.D., G.D., M.A.G.)
| | - Philip S. Marino
- From the Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom (P.M., K.D., E.L., I.G., A.K., G.D., L.S., S.J.W., P.S.M., M.A.G., W.L.); Pasteur University Hospital, Nice, France (P.M.); and National Institute for Health Research Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, and National Heart and Lung Institute, Imperial College School of Medicine, London, United Kingdom (K.D., G.D., M.A.G.)
| | - Michael A. Gatzoulis
- From the Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom (P.M., K.D., E.L., I.G., A.K., G.D., L.S., S.J.W., P.S.M., M.A.G., W.L.); Pasteur University Hospital, Nice, France (P.M.); and National Institute for Health Research Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, and National Heart and Lung Institute, Imperial College School of Medicine, London, United Kingdom (K.D., G.D., M.A.G.)
| | - Wei Li
- From the Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom (P.M., K.D., E.L., I.G., A.K., G.D., L.S., S.J.W., P.S.M., M.A.G., W.L.); Pasteur University Hospital, Nice, France (P.M.); and National Institute for Health Research Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, and National Heart and Lung Institute, Imperial College School of Medicine, London, United Kingdom (K.D., G.D., M.A.G.)
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