31st Annual Meeting and Scientific Sessions
SAN DIEGO – For patients with pulmonary arterial hypertension, a
history of presyncope and syncope worsened the severity of disease, according
to data from the REVEAL registry.
What this indicates, according to researchers, is the importance of
validating the prognosis and effect of syncope among patients with pulmonary
arterial hypertension (PAH) as treatment guidelines continue to be defined.
The study featured patients (n=70) who had both
PAH and a history of either presyncope or
syncope at initial prediagnosis of symptoms (IS) and first
PAH-clinic visit from the REVEAL registry, which was a 55-center,
observational, US-based longitudinal registry. The study’s objective was
to both define the significance of presyncope and syncope in newly diagnosed
patients with PAH and determine whether it is linked with clinical and or
Inclusion criteria for the study was that all patients with PAH must be
characterized by having each of the following: mean pulmonary artery pressure
<25 mm Hg at rest or <30 mm Hg with exercise; pulmonary capillary wedge
pressure or left ventricular end-diastolic pressure no greater than 18 mm Hg;
and pulmonary vascular resistance of at least 240 dyn/s/cm-5.
Patients were then followed for at least 5 years.
The researchers reported that patients with PAH and a history of
presyncope and syncope were younger; had higher mean pulmonary artery pressure
and right atrial pressure; had more functional class IV disease; had more right
ventricular chamber enlargement; and had higher percent predicted diffusing
capacity of carbon dioxide. They also found that 3-year survival was worse for
the IS group despite these patients being characterized as younger and having a
better capacity for exercise.
“Presyncope/syncope is associated with markers of increased disease
severity in newly diagnosed PAH patients. However, it was not predictive of
unadjusted survival,” said Rachel Le, MD, with the Mayo Clinic,
Rochester, Minn., and investigator on the study, in her presentation.
As directions for future research, Le and colleagues suggested
determination of the prognosis of presyncope or syncope as evidence-based PAH
treatment guidelines are established; separating out the differences between
presyncope or syncope; accessing whether treatment will affect prognosis in
these patients; the effect of resolution of these symptoms with therapy; and
differentiating pediatric vs. adult patients. – by Brian Ellis
For more information:
- Le R. Abstract #20. Presented at: ISHLT 31st Annual Meeting and
Scientific Sessions; April 13-16, 2011; San Diego.
To me, the interesting aspect of this data was validation of something
that has been repeatedly mentioned by astute clinicians of yesteryear: the
relationship of presyncope and syncope to severity of PAH. It was an elegant
analysis of an important registry and raises the question of a pathophysiologic
link of syncope/presyncope to worsening PAH and not just something that is a
consequence of PAH.
– James Young, MD
Today Section Editor
Disclosure: Drs. Le and Young reported no relevant financial