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Incidence, predictors, and clinical course of atrial tachyarrhythmias in patients with pulmonary hypertension

  • Arun Kanmanthareddy
  • Yeruva Madhu Reddy
  • Hemant Boolani
  • Sowjanya Duthuluru
  • Jayasree Pillarisetti
  • Ajay Vallakati
  • Sudharani Bommana
  • Donita Atkins
  • Timothy Williamson
  • Dhanunjaya Lakkireddy
Article

Abstract

Background

The prevalence and predictors of atrial tachyarrhythmias (ATa) in patients with pulmonary hypertension (PH) is less well understood.

Methods

We performed a retrospective study including 311 patients with PH, confirmed by 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 ± 20 mmHg, mean left ventricular ejection fraction (LVEF) was 55 ± 13 %, and mean pulmonary capillary wedge pressure (PCWP) was 19 ± 9 mmHg. Of the 311 patients with PH, 121 (39 %) patients had 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). There was no difference in the prevalence of ATa in mild, moderate, or severe PH. The mean PCWP was higher in patients with ATa (17.9 ± 9 vs 20.3 ± 8; p = 0.022). In multivariate analysis using Cox-proportional hazard model, the independent predictors of mortality 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 (HR 1.023; p = 0.003).

Conclusion

ATa are common in patients with PH. Left heart disease, left atrial enlargement, and elevated PCWP but not right atrial enlargement or mPAP predict the occurrence of ATa in patients with PH.

Keywords

Atrial tachyarrhythmias Pulmonary hypertension Supraventricular tachycardia Pulmonary arterial hypertension 

Abbreviations

PH

Pulmonary hypertension

AF

Atrial fibrillation

SVT

Supraventricular tachycardia

ATa

Atrial tachyarrhythmia

LVEF

Left ventricular ejection fraction

PCWP

Pulmonary capillary wedge pressure

RHC

Right heart catheterization

mPAP

Mean pulmonary artery pressure

Notes

Conflict of interest

None relevant to the current study.

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Arun Kanmanthareddy
    • 1
  • Yeruva Madhu Reddy
    • 1
  • Hemant Boolani
    • 2
  • Sowjanya Duthuluru
    • 3
  • Jayasree Pillarisetti
    • 1
  • Ajay Vallakati
    • 4
  • Sudharani Bommana
    • 1
  • Donita Atkins
    • 1
  • Timothy Williamson
    • 3
  • Dhanunjaya Lakkireddy
    • 1
  1. 1.Division of Cardiovascular Diseases and Bloch Heart Rhythm Center, Cardiovascular Research InstituteUniversity of Kansas Hospital and Medical CenterKansas CityUSA
  2. 2.Division of CardiologyHoward UniversityWashingtonUSA
  3. 3.Division of Pulmonary Critical CareUniversity of Kansas Hospital and Medical CenterKansas CityUSA
  4. 4.Division of Cardiology, Metrohealth Medical CenterCase Western Reserve UniversityClevelandUSA

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