Kanmanthareddy Arun, Reddy Yeruva Madhu, Boolani Hemant, Duthuluru Sowjanya, Pillarisetti Jayasree, Vallakati Ajay, Bommana Sudharani, Atkins Donita, Williamson Timothy, Lakkireddy Dhanunjaya
Division of Cardiovascular Diseases and Bloch Heart Rhythm Center, Cardiovascular Research Institute, University of Kansas Hospital and Medical Center, 3901 Rainbow Boulevard MS 4023, Kansas City, KS, 66160-7200, USA.
J Interv Card Electrophysiol. 2014 Oct;41(1):9-14. doi: 10.1007/s10840-014-9928-5. Epub 2014 Jul 9.
The prevalence and predictors of atrial tachyarrhythmias (ATa) in patients with pulmonary hypertension (PH) is less well understood.
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.
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).
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.
肺动脉高压（PH）患者房性快速性心律失常（ATa）的患病率及预测因素尚不太清楚。
我们进行了一项回顾性研究，纳入了2007年至2011年间在本中心经右心导管检查确诊的311例PH患者。收集了有或无ATa患者的基线特征、临床、超声心动图和血流动力学数据并进行比较。
平均年龄为61±13岁，女性占64%。平均肺动脉压（mPAP）为46±20 mmHg，平均左心室射血分数（LVEF）为55±13%，平均肺毛细血管楔压（PCWP）为19±9 mmHg。在311例PH患者中，121例（39%）有ATa。有ATa的患者年龄更大（p<0.001），更可能患有系统性高血压（p=0.03）、糖尿病（p=0.015）、冠状动脉疾病（p<0.001）、心力衰竭（p<0.001）、二尖瓣反流（p=0.001）、LVEF受损（p=0.02）和左心房扩大（p<0.001）。轻度、中度或重度PH患者中ATa的患病率无差异。有ATa的患者平均PCWP更高（17.9±9 vs 20.3±8；p=0.022）。在使用Cox比例风险模型的多变量分析中，死亡的独立预测因素为年龄（HR 1.05；p=0.003）、冠状动脉疾病（HR 2.34；p=0.047）、LVEF（HR 0.793；p=0.023）和mPAP（HR 1.023；p=0.003）。
ATa在PH患者中很常见。左心疾病、左心房扩大和PCWP升高可预测PH患者ATa的发生，而右心房扩大或mPAP则不能。
