Inflammatory markers in Eisenmenger syndrome and their association with clinical outcomes. A cross-sectional comparative study

Background: Inflammation may be an important factor contributing to the progression of Eisenmenger syndrome (ES). The purpose of the current study was to: characterize the inflammatory profile in ES patients and compare measures to reference values for congenital heart disease and pulmonary arterial hypertension (CHD-PAH); and investigate whether inflammatory markers are associated with other clinical markers in ES. Methods: Twenty-seven ES patients were prospectively selected and screened for systemic inflammatory markers, including interleukin (IL)-1 beta, tumor necrosis factor-alpha (TNF-alpha) and IL-10. Clinical data and echocardiographic parameters were obtained, with concomitant analysis of ventricular function. Functional capacity was assessed using the 6-min walk test (6MWT). Renal function and blood homeostasis were evaluated by the level of blood urea nitrogen (BUN), creatinine, and plasma electrolytes. Results: Patients with ES expressed higher IL-10, IL-1 beta and TNF-alpha compared to reference values of patients with CHD-PAH. IL-10 was negatively associated with BUN (r = - 0.39,p = 0.07), creatinine (r = -0.35, p = 0.002), sodium (r = -0.45, p = 0.03), and potassium (r = -0.68, p = 0.003). IL-10 was positively associated with bicarbonate (r = 0.45, p = 0.02) and trended toward a positive association with right ventricular fractional area change (RVFAC) (r = 0.35, p = 0.059). IL-1 beta was negatively associated with potassium (r = -0.5, p = 0.01). TNF alpha demonstrated positive association with creatinine (r = 0.4,p = 0.006), BUN (r = 0.63,p = 0.003), sodium (r = 0.44, p = 0.04), potassium (r = 0.41, p = 0.04), and was negatively associated with RVFAC (r = - 0.38,p = 0.03) and 6MWT distance (r = -0.54, p = 0.004). Conclusion: ES patients exhibit a more severe inflammatory profile compared to reference values for CHD-PAH. Furthermore, inflammatory markers are related to renal dysfunction, right ventricular impairment and poorer functional capacity.

Automated summary

Patients with Eisenmenger syndrome show a more severe inflammatory profile compared to those with congenital heart disease and pulmonary arterial hypertension. Inflammatory markers are associated with renal dysfunction, right ventricular impairment, and poorer functional capacity in ES patients.