TY - JOUR
T1 - Syncope in adults with pulmonary arterial hypertension
AU - Le, Rachel J.
AU - Fenstad, Eric R.
AU - Maradit-Kremers, Hilal
AU - McCully, Robert B.
AU - Frantz, Robert P.
AU - McGoon, Michael D.
AU - Kane, Garvan C.
N1 - Funding Information:
This work was supported in part by an unrestricted research grant from Pfizer to Dr. Maradit-Kremers and by the Mayo Clinic CR20 program to Dr. Kane. Dr. Frantz has received research and education grants, unrelated to this project, from United Therapeutics , Actelion , Pfizer , and Gilead . Unrelated to this project, Dr. McGoon has received research funding from Medtronic and Gilead; served on advisory, steering, and/or endpoint/data and safety monitoring board committees for Actelion, Gilead, LungRx, and Medtronic; and has received honoraria for speaking at conferences supported by Actelion and Gilead. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
PY - 2011/8/16
Y1 - 2011/8/16
N2 - Objectives: The aim of this study was to determine the prognostic significance of syncope in pulmonary arterial hypertension (PAH). Background: Some patients with PAH have a history of syncope at presentation. The prognostic implications of syncope in PAH have not yet been well characterized. Methods: This was a single-center cohort study of 378 patients with PAH seen at a dedicated pulmonary hypertension clinic over an 8-year period. All patients completed a standardized symptom assessment at the time of diagnosis. Results: Forty-five (12%) patients had a history of syncope at the time of PAH diagnosis. There were no significant differences in sex, age, functional class, 6-min walk distance, or etiology of PAH in syncopal versus nonsyncopal patients. Syncopal patients presented with higher right atrial pressure and lower cardiac outputs with lower survival rates (1-, 3-, and 5-year rates): 69% (95% confidence interval [CI]: 54% to 81%); 51% (95% CI: 36% to 65%); and 37% (95% CI: 24% to 53%), respectively, compared with 82% (95% CI: 77% to 86%); 64% (95% CI: 64% to 69%); and 54% (95% CI: 48% to 59%), respectively, in nonsyncopal patients. Syncope was a significant predictor of mortality (hazard ratio: 1.94, 95% CI: 1.20 to 2.99), after adjusting for age, sex, functional class, 6-min walk distance, diffusing capacity of carbon monoxide, and right atrial pressure. Syncopal patients had similarly poor outcomes compared with nonsyncopal patients presenting with class 4 symptoms. Conclusions: Syncope in PAH is associated with worsening right heart function and is an independent predictor of a poor prognosis.
AB - Objectives: The aim of this study was to determine the prognostic significance of syncope in pulmonary arterial hypertension (PAH). Background: Some patients with PAH have a history of syncope at presentation. The prognostic implications of syncope in PAH have not yet been well characterized. Methods: This was a single-center cohort study of 378 patients with PAH seen at a dedicated pulmonary hypertension clinic over an 8-year period. All patients completed a standardized symptom assessment at the time of diagnosis. Results: Forty-five (12%) patients had a history of syncope at the time of PAH diagnosis. There were no significant differences in sex, age, functional class, 6-min walk distance, or etiology of PAH in syncopal versus nonsyncopal patients. Syncopal patients presented with higher right atrial pressure and lower cardiac outputs with lower survival rates (1-, 3-, and 5-year rates): 69% (95% confidence interval [CI]: 54% to 81%); 51% (95% CI: 36% to 65%); and 37% (95% CI: 24% to 53%), respectively, compared with 82% (95% CI: 77% to 86%); 64% (95% CI: 64% to 69%); and 54% (95% CI: 48% to 59%), respectively, in nonsyncopal patients. Syncope was a significant predictor of mortality (hazard ratio: 1.94, 95% CI: 1.20 to 2.99), after adjusting for age, sex, functional class, 6-min walk distance, diffusing capacity of carbon monoxide, and right atrial pressure. Syncopal patients had similarly poor outcomes compared with nonsyncopal patients presenting with class 4 symptoms. Conclusions: Syncope in PAH is associated with worsening right heart function and is an independent predictor of a poor prognosis.
KW - cardiac catheterization
KW - echocardiography
KW - mortality
KW - prediction
KW - pulmonary hypertension
KW - syncope
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U2 - 10.1016/j.jacc.2011.04.026
DO - 10.1016/j.jacc.2011.04.026
M3 - Article
C2 - 21835323
AN - SCOPUS:80051657862
SN - 0735-1097
VL - 58
SP - 863
EP - 867
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 8
ER -