Cannillo Margherita, Grosso Marra Walter, Gili Sebastiano, D'Ascenzo Fabrizio, Morello Mara, Mercante Lorena, Mistretta Elisa, Salera Davide, Zema Domenica, Bissolino Arianna, Fusaro Enrico, Marra Sebastiano, Libertucci Daniela, Gaita Fiorenzo
Division of Cardiology, University of Turin, Città Della Salute e Della Scienza, Turin, Italy.
Division of Cardiology, University of Turin, Città Della Salute e Della Scienza, Turin, Italy.
Am J Cardiol. 2015 Dec 15;116(12):1883-9. doi: 10.1016/j.amjcard.2015.09.039. Epub 2015 Oct 9.
The onset of supraventricular arrhythmias (SVA) may be associated with clinical worsening in patients with pulmonary arterial hypertension (PAH). However, limited data have been reported, especially at long-term follow-up. Aim of this study was to investigate the incidence of SVA in our patients with PAH, the risk factors correlated to their onset and the prognostic impact. All consecutive patients with PAH without history of SVA were enrolled. Incidence of new SVA was investigated and also the risk factors for SVA. Primary end point of the study was the impact of SVA on a composite of all-cause mortality and re-hospitalization, whereas mortality was the secondary end point. Seventy-seven patients were enrolled. No significant differences in the clinical or instrumental baseline characteristics between the 2 study groups were reported. During a median follow-up of 35 months (interquartile range 21.5 to 53.5), 17 (22%) patients experienced SVA. Development of SVA was associated with worsening of prognostic parameters at the follow-up: increasing of World Health Organization (WHO) functional class (p = 0.005) and N-terminal-pro-brain natriuretic peptide (NT-proBNP) (p = 0.018) and reduction of 6-minute walking distance (p = 0.048), tricuspid annular plane systolic excursion (TAPSE) (p = 0.041), and diffusing capacity of the lung for carbon monoxide (p = 0.025). The primary end point occurred in 13 patients (76%) in the SVA group and in 22 patients (37%) in the group without SVA (p = 0.004), whereas 9 patients (53%) among those with SVA died during the follow-up compared with 8 (13%) among those without (p = 0.001). At multivariate analysis, development of SVA was independently associated with an increased risk to meet the both primary (hazard ratio 2.13; 95% confidence interval 1.07 to 4.34; p = 0.031) and secondary (hazard ratio 4.1; 95% confidence interval 1.6 to 10.6; p = 0.004) end points. In conclusion, during the 3-year follow-up period, 1/3 of patients with PAH developed SVA, which was related to worsening of hemodynamic and functional parameter and independently predicted adverse prognosis.
室上性心律失常（SVA）的发作可能与肺动脉高压（PAH）患者的临床病情恶化有关。然而，相关报道的数据有限，尤其是长期随访数据。本研究的目的是调查我们PAH患者中SVA的发生率、与其发作相关的危险因素以及预后影响。纳入所有无SVA病史的连续PAH患者。研究新发SVA的发生率以及SVA的危险因素。研究的主要终点是SVA对全因死亡率和再次住院综合指标的影响，而死亡率是次要终点。共纳入77例患者。两个研究组在临床或器械检查基线特征方面未报告有显著差异。在中位随访35个月（四分位间距21.5至53.5个月）期间，17例（22%）患者发生SVA。SVA的发生与随访时预后参数的恶化相关：世界卫生组织（WHO）功能分级增加（p = 0.005）、N末端脑钠肽前体（NT-proBNP）升高（p = 0.018）以及6分钟步行距离缩短（p = 0.048）、三尖瓣环平面收缩期位移（TAPSE）降低（p = 0.041）和肺一氧化碳弥散量降低（p = 0.025）。主要终点在SVA组的13例患者（76%）和无SVA组的22例患者（37%）中出现（p = 0.004），而SVA患者中有9例（53%）在随访期间死亡，无SVA患者中有8例（13%）死亡（p = 0.001）。多因素分析显示，SVA的发生与达到主要终点（风险比2.13；95%置信区间1.07至4.34；p = 0.031）和次要终点（风险比4.1；95%置信区间1.6至10.6；p = 0.004）的风险增加独立相关。总之，在3年随访期内，1/3的PAH患者发生SVA，这与血流动力学和功能参数的恶化有关，并独立预测不良预后。
