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Eisenmenger syndrome (ES) is the latest stage of congenital heart disease associated pulmonary arterial hypertension (PAH) and is more common in our daily practice lately. Despite all improvements, there are several limitations to determining prognosis of these patients (1). Therefore, different parameters with high prognostic values are needed. Heart rate variability (HRV) and autonomic dysfunction can be early prognostic markers in patients with ES. Twenty patients with ES (12 female, 8 male) and 20 healthy matched volunteers were enrolled in the study. Plasma brain natriuretic peptide (BNP) and troponin-I levels were measured. HRV parameters were calculated from 24-hour Holter electrocardiogram recordings. HRV parameters were compared with those of 20 healthy subjects. Bivariate analysis was performed to evaluate correlation between echocardiographic parameters and plasma BNP, high sensitivity (hs)-troponin-I levels. Mean age was 29.25±12.53 years and patients were clinically stable. All patients were receiving specific pulmonary hypertension treatment. Eight patients (40%) were receiving combination therapy, while 12 patients (60%) were receiving single agent. There were significantly lower time-domain HRV parameters [SD of all RR intervals (SDNN): 125.8±36.96 vs. 173.30±34.47 (p<0.0001); mean of SD of all RR intervals for all 5-minute segments over the entire recording (SDNNi): 48.30±14.65 vs. 71.65±19.74 (p<0.0001); SD of averaged normal RR intervals calculated for all 5-minute periods (SDANN): 116.15±37.22 vs. 157.00±31.18 (p<0.0001); 32.25±14.32 vs. 39.05±14.98 (p=0.151); triangular index (TI): 40.31±20.05 vs. 48.45±14.16 (p=0.150)] in ES patients compared to healthy controls. Root-mean-square of successive normal sinus RR interval difference (RMSSD) and TI were lower in ES patients, but without statistical significance (p=0.151). Anatol J Cardiol 2017; 17: 75-80 Letters to the Editor 78

Heart rate variability in Eisenmenger syndrome and its correlation with echocardiographic parameters and plasma BNP, high sensitivity troponin-I level