Abstract 17933: Incidence, Predictors and Clinical Course of Atrial Tachyarrhythmias in Patients with Pulmonary Hypertension
Background: The clinical profile of atrial tachyarrhythmias (ATa) in patients with pulmonary hypertension (PHTN) is less well understood.
Methods: We studied 311 patients with PHTN confirmed with right heart catheterization in our center between 2007 and 2011. Baseline characteristics, clinical, echocardiographic and hemodynamic data were collected and compared between patients with and without ATa.
Results: The mean age was 61±13 years with 64% females. The mean pulmonary artery pressure (mPAP) was 46±20mmHg, mean left ventricular ejection fraction (LVEF) was 55±13 and mean pulmonary capillary wedge pressure (PCWP) was 19±9mmHg. 121 (39%) patients had ATa. When compared to those without ATa, patients with ATa were older (p<0.001) and were more likely to have systemic hypertension (p=0.03), diabetes (p=0.015), coronary artery disease (p<0.001), heart failure (p<0.001), mitral regurgitation (p=0.001), impaired LVEF (p=0.02) and left atrial enlargement (p<0.001). The right atrial size and mPAP did not differ between both the groups. Also, there was no difference in the prevalence of ATa in mild, moderate or severe PHTN. However, the mean PCWP was higher in patients with ATa supporting a larger impact of left heart disease on the prevalence of ATa. Even in the 95 patients with normal PCWP (PCWP<15), right atrial size and mPAP did not differ between those with and without ATa. After a mean follow-up of 22 ±14 months, 35 (12%) patients died, with no significant different between those with and without ATa. The independent predictors of mortality in Cox-proportional hazard model were age (HR 1.05; p=0.003), coronary artery disease (HR 2.34; p=0.047), LVEF (HR 0.793; p =0.023) and mPAP (1.023; p=0.003).
Conclusion: ATa is common in patients with PHTN. Left heart disease, left atrial enlargement and elevated PCWP but not right atrial enlargement or mPAP predict ATa in patients with PHTN.
- © 2012 by American Heart Association, Inc.