Syncope in adults with pulmonary arterial hypertension

Rachel J. Le, Eric R. Fenstad, Hilal D Maradit Kremers, Robert B. McCully, Robert Frantz, Michael D. McGoon, Garvan M Kane

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)863-867
Number of pages5
JournalJournal of the American College of Cardiology
Volume58
Issue number8
DOIs
StatePublished - Aug 16 2011

Fingerprint

Syncope
Pulmonary Hypertension
Confidence Intervals
Atrial Pressure
Symptom Assessment
Carbon Monoxide
Sex Characteristics
Cardiac Output
Cohort Studies
Survival Rate
Mortality

Keywords

  • cardiac catheterization
  • echocardiography
  • mortality
  • prediction
  • pulmonary hypertension
  • syncope

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Syncope in adults with pulmonary arterial hypertension. / Le, Rachel J.; Fenstad, Eric R.; Maradit Kremers, Hilal D; McCully, Robert B.; Frantz, Robert; McGoon, Michael D.; Kane, Garvan M.

In: Journal of the American College of Cardiology, Vol. 58, No. 8, 16.08.2011, p. 863-867.

Research output: Contribution to journalArticle

Le, Rachel J. ; Fenstad, Eric R. ; Maradit Kremers, Hilal D ; McCully, Robert B. ; Frantz, Robert ; McGoon, Michael D. ; Kane, Garvan M. / Syncope in adults with pulmonary arterial hypertension. In: Journal of the American College of Cardiology. 2011 ; Vol. 58, No. 8. pp. 863-867.
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abstract = "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.",
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AU - Fenstad, Eric R.

AU - Maradit Kremers, Hilal D

AU - McCully, Robert B.

AU - Frantz, Robert

AU - McGoon, Michael D.

AU - Kane, Garvan M

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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.

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