Hjalmarsson Clara, Lindgren Martin, Bergh Niklas, Hornestam Björn, Smith J G, Adiels Martin, Rosengren Annika
Department of Cardiology Sahlgrenska University Hospital Gothenburg Sweden.
Department of Molecular and Clinical Medicine, Institute of Medicine at Sahlgrenska Academy University of Gothenburg Gothenburg Sweden.
J Am Heart Assoc. 2025 May 6;14(9):e037418. doi: 10.1161/JAHA.124.037418. Epub 2025 May 2.
Atrial fibrillation (AF) is suggested to be associated with venous thromboembolism (VTE) and might thereby play a role in the development of chronic thromboembolic pulmonary hypertension (PH). By elevating left-sided filling pressure and promoting atrial myopathy, AF may also play a role in the development of postcapillary PH. We aimed to investigate the association between AF, with or without incident VTE, and the occurrence of PH.
A total of 521 988 patients diagnosed with AF between 1987 and 2013, without a previous diagnosis of VTE or PH, were identified from the Swedish National Patient Register and matched for age, sex, and county with 1 017 277 population controls without AF, VTE, or PH.
The mean age of the patients with AF was 71.1 (SD ±10.1) years and 42.8% were women. During a median follow-up period of 11 (interquartile range 5.1-17) years, 4454 (0.9%) patients with AF, and 1855 (0.2%) controls were diagnosed with PH, hazard ratio 4.7 (4.4-5.0). The AF group had a significantly higher comorbidity burden at baseline, with a mean CHADS-VASc of 2.9 compared with 2.1 in controls. In the absence of intercurrent VTE, the hazard ratio of PH was 4.2 (3.9-4.5) among patients with AF compared with controls. Intercurrent VTE increased the hazard ratio of PH a further 1.9-fold (1.7-2.1) and 3.5 (3.1-4.0), among patients with AF and controls, respectively. The hazard ratio for PH in patients with AF with incident VTE was 8.1 (7.3-9.1).
AF was associated with a markedly increased risk of developing incident PH, and this risk was further increased by incident VTE.
房颤（AF）被认为与静脉血栓栓塞（VTE）有关，因此可能在慢性血栓栓塞性肺动脉高压（PH）的发生中起作用。通过升高左心房充盈压和促进心房肌病，房颤也可能在毛细血管后肺动脉高压的发生中起作用。我们旨在研究伴有或不伴有新发VTE的房颤与肺动脉高压发生之间的关联。
从瑞典国家患者登记处识别出1987年至2013年间共521988例诊断为房颤且既往未诊断为VTE或PH的患者，并将其与1017277例无房颤、VTE或PH的人群对照按年龄、性别和所在县进行匹配。
房颤患者的平均年龄为71.1（标准差±10.1）岁，42.8%为女性。在中位随访期11（四分位间距5.1 - 17）年期间，4454例（0.9%）房颤患者和1855例（0.2%）对照被诊断为肺动脉高压，风险比为4.7（4.4 - 5.0）。房颤组在基线时合并症负担显著更高，平均CHADS - VASc评分为2.9，而对照组为2.1。在无并发VTE的情况下，房颤患者发生肺动脉高压的风险比为4.2（3.9 - 4.5），与对照组相比。并发VTE分别使房颤患者和对照组发生肺动脉高压的风险比进一步增加1.9倍（1.7 - 2.1）和3.5倍（3.1 - 4.0）。伴有新发VTE的房颤患者发生肺动脉高压的风险比为8.1（7.3 - 9.1）。
房颤与新发肺动脉高压的风险显著增加相关，且这种风险因新发VTE而进一步增加。
