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J Am Coll Cardiol. 2011 Aug 16;58(8):863-7. doi: 10.1016/j.jacc.2011.04.026.

Syncope in adults with pulmonary arterial hypertension.

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1
Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.

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.

PMID:
21835323
DOI:
10.1016/j.jacc.2011.04.026
[Indexed for MEDLINE]
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