Key result
Pre-tricuspid shunt in Eisenmenger syndrome was associated with an increased risk of all-cause mortality or heart failure readmission compared to post-tricuspid shunt.
Why the study?
Congenital shunt location affects survival in Eisenmenger syndrome, and right ventricular remodeling is linked to poor pulmonary hypertension outcomes, prompting investigation into MRI-evaluated remodeling and prognosis across shunt locations.
Does shunt location (pre-tricuspid vs post-tricuspid) affect right ventricular remodeling and prognosis in adults with Eisenmenger syndrome?
Observational (n=54)
Does shunt location (pre-tricuspid vs post-tricuspid) affect right ventricular remodeling and prognosis in adults with Eisenmenger syndrome?
In adults with Eisenmenger syndrome, a pre-tricuspid shunt is associated with worse right ventricular remodeling and a significantly higher risk of mortality or heart failure readmission compared to a post-tricuspid shunt.
Answers are grounded in this paper and cite their sources.
Pre-tricuspid ES patients show adverse RV remodeling linked to poorer survival; supports MRI risk stratification but hypothesis-generating pending validation.
BACKGROUND: Congenital shunt location is related to Eisenmenger syndrome (ES) survival. Moreover, right ventricular (RV) remodeling is associated with poor survival in pulmonary hypertension. PURPOSE: To investigate RV remodeling using comprehensive magnetic resonance imaging (MRI) techniques and identify its relationship with prognosis in ES subgroups classified by shunt location. STUDY TYPE: Prospective observational study. POPULATION: Fifty-four adults with ES (16 with pre-tricuspid shunt and 38 with post-tricuspid shunt). FIELD STRENGTH/SEQUENCE: 3.0 T/cine MRI with balanced steady-state free precession sequence, late gadolinium enhancement with inversion recovery segmented gradient echo sequence and phase-sensitive reconstruction, and T1 mapping with modified Look-Locker inversion recovery sequence. ASSESSMENT: Demographics, clinical characteristics, hemodynamics, RV remodeling features (morphology, systolic function, RV-pulmonary artery (PA) coupling and myocardial fibrosis), and prognosis were compared between ES subgroups. The adverse endpoint was all-cause mortality or readmission for heart failure. STATISTICAL TESTS: The independent samples t-test, Fisher's exact test or Chi-squared test, and the Kaplan-Meier method were used. P < 0.05 was considered significant. RESULTS: ), worse RV ejection fraction (23.54% ± 12.35% vs. 40.82% ± 10.77%), and RV-PA decoupling (0.35 ± 0.31 vs. 0.72 ± 0.29). Biventricular myocardial fibrosis was significantly more severe in pre-tricuspid shunt than post-tricuspid shunt (extracellular volume, left ventricle: 35.85% ± 2.58% vs. 29.10% ± 5.20%; RV free wall: 30.93% ± 5.65% vs. 26.75% ± 5.15%). In addition, pre-tricuspid shunt demonstrated a significantly increased risk of adverse endpoint (hazard ratio: 2.938, 95% confidence interval: 1.204-7.172). DATA CONCLUSION: ES with pre-tricuspid shunt might be a unique subtype with worse clinically decompensated RV remodeling and poor prognosis. LEVEL OF EVIDENCE: 2 Technical Efficacy Stage: 5.
No takes yet. Share an insight, caveat, or question.
Gong et al. (2021) conducted an observational in Eisenmenger syndrome (n=54). Pre-tricuspid shunt vs. Post-tricuspid shunt was evaluated on All-cause mortality or readmission for heart failure (HR 2.938, 95% CI 1.204-7.172). Pre-tricuspid shunt in Eisenmenger syndrome was associated with an increased risk of all-cause mortality or heart failure readmission compared to post-tricuspid shunt.
Synapse has enriched 10 related papers. Consider them for comparative context: