Left ventricular dysfunction before therapy is predictor for mortality in adult patients with Eisenmenger syndrome

The purpose of this retrospective analysis was to identify possible risk factors for mortality among a cohort of patients with Eisenmenger after advanced medical therapy.

Patients and Methods: The clinical endpoint of this analysis was either mortality or heart lung transplantation.14 patients reached the clinical endpoint (group 1). Their initial six minute walk test, pro-BNP and data regarding ventricular function derived from conventional and 2D speckle tracking echocardiography of group 1 were compared to the rest of the patients without HLTX or death (group 2).

Results: No significant difference was found between the two groups regarding the age, heart rate and six minutes walk test at the start of the therapy. However, by inclusion the patients in the initial therapy study with Bosentan Patient with either HLTX or death (group 1) had significantly higher pro-BNP (4717 vs. 756 pg/ml, p=0.017), lower LV mean strain (17.7 vs. 13.08%, p=0.004) and lower LV area fraction (41 vs. 51%, p=0.015). The Tricuspid annular peak systolic excursion, right ventricular mean strain did not differ significantly between both groups of patients. For prediction of mortality the area under the ROC curve was 0.73 for pro-BNP, 0.76 for LV mean strain and 0.77 LVEF).

Conclusions: left rather than right ventricular dysfunction and higher pro-BNP levels before Bosentan therapy seem to have higher predictive risk for mortality or HLTX during follow-up in adult patients with Eisenmenger syndrome despite the advance therapy.