TY - JOUR
T1 - Pulmonary arterial hypertension and atrial arrhythmias
T2 - incidence, risk factors, and clinical impact
AU - Mercurio, Valentina
AU - Peloquin, Grace
AU - Bourji, Khalil I.
AU - Diab, Nermin
AU - Sato, Takahiro
AU - Enobun, Blessing
AU - Housten-Harris, Traci
AU - Damico, Rachel
AU - Kolb, Todd M.
AU - Mathai, Stephen C.
AU - Tedford, Ryan J.
AU - Tocchetti, Carlo G.
AU - Hassoun, Paul M.
N1 - Funding Information:
This research is supported by NIH/NHLBI R01 HL114910 and U01HL125175-01 (PMH). VM received a grant from Italian Society of Cardiology-Merck Sharp & Dohme.
Publisher Copyright:
© 2018, The Author(s) 2018.
PY - 2018/4/1
Y1 - 2018/4/1
N2 - Atrial arrhythmia (AA) occurrence in pulmonary arterial hypertension (PAH) may determine clinical deterioration and affect prognosis. In this study we assessed AA incidence in idiopathic (IPAH) and systemic sclerosis related PAH (SSc-PAH) and evaluated risk factors, management, and impact on mortality. We collected baseline data from consecutive IPAH or SSc-PAH patients prospectively enrolled in the Johns Hopkins Pulmonary Hypertension Registry between January 2000 and July 2016. During follow-up AA onset, treatment, and outcome were recorded. Among 317 patients (201 SSc-PAH, 116 IPAH), 42 developed AA (19 atrial fibrillation, 10 flutter-fibrillation, 9 atrial flutter, and 4 atrial ectopic tachycardia) with a 13.2% cumulative incidence. Most events were associated with hospitalization (90.5%). Electrical or pharmacological cardioversion was attempted in most cases. Patients with AA had higher right atrial pressure, pulmonary wedge pressure (P < 0.005), NT-proBNP (P < 0.05), and thyroid disease prevalence (P < 0.005). Higher mortality was observed in patients with AA, though not statistically significant (LogRank P = 0.323). Similar long-term mortality between IPAH with AA and SSc-PAH without AA was observed (LogRank P = 0.098). SSc-PAH with AA had the worst prognosis. In PAH patients AA occurrence is a matter of significant concern. Therapeutic strategies aimed at restoring sinus rhythm may represent an important goal.
AB - Atrial arrhythmia (AA) occurrence in pulmonary arterial hypertension (PAH) may determine clinical deterioration and affect prognosis. In this study we assessed AA incidence in idiopathic (IPAH) and systemic sclerosis related PAH (SSc-PAH) and evaluated risk factors, management, and impact on mortality. We collected baseline data from consecutive IPAH or SSc-PAH patients prospectively enrolled in the Johns Hopkins Pulmonary Hypertension Registry between January 2000 and July 2016. During follow-up AA onset, treatment, and outcome were recorded. Among 317 patients (201 SSc-PAH, 116 IPAH), 42 developed AA (19 atrial fibrillation, 10 flutter-fibrillation, 9 atrial flutter, and 4 atrial ectopic tachycardia) with a 13.2% cumulative incidence. Most events were associated with hospitalization (90.5%). Electrical or pharmacological cardioversion was attempted in most cases. Patients with AA had higher right atrial pressure, pulmonary wedge pressure (P < 0.005), NT-proBNP (P < 0.05), and thyroid disease prevalence (P < 0.005). Higher mortality was observed in patients with AA, though not statistically significant (LogRank P = 0.323). Similar long-term mortality between IPAH with AA and SSc-PAH without AA was observed (LogRank P = 0.098). SSc-PAH with AA had the worst prognosis. In PAH patients AA occurrence is a matter of significant concern. Therapeutic strategies aimed at restoring sinus rhythm may represent an important goal.
KW - atrial arrhythmias
KW - pulmonary arterial hypertension
KW - systemic sclerosis
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U2 - 10.1177/2045894018769874
DO - 10.1177/2045894018769874
M3 - Article
C2 - 29575972
AN - SCOPUS:85049920539
SN - 2045-8932
VL - 8
JO - Pulmonary Circulation
JF - Pulmonary Circulation
IS - 2
ER -