title: Clinical impact of atrial fibrillation in patients with pulmonary hypertension.
abstract: BACKGROUND
  Pulmonary hypertension (PH) is associated with progressive impairment of right ventricular function, reduced exercise capacity and a poor prognosis. Little is known about the prevalence, clinical manifestation and impact of atrial fibrillation (AF) on cardiac function in PH.
  
  
  METHODS
  In a four year single-centre retrospective analysis 225 patients with confirmed PH of various origins were enrolled to investigate the prevalence of AF, and to assess the clinical manifestation, 6-minute walk distance, NT-proBNP levels, echocardiographic parameters and hemodynamics obtained by right heart catheterization in PH with AF.
  
  
  RESULTS
  AF was prevalent in 31.1%. In patients with PH and AF, parameters of clinical deterioration (NYHA/WHO functional class, 6-minute walk distance, NT-proBNP levels) and renal function were significantly compromised compared to patients with PH and sinus rhythm (SR). In the total PH cohort and in PH not related to left heart disease occurrence of AF was associated with an increase of right atrial pressure (RAP) and right atrial dilatation. While no direct association was found between pulmonary artery pressure (PAP) and AF in these patients, right ventricular function was reduced in AF, indicating more advanced disease. In PH due to left heart failure the prevalence of AF was particularly high (57.7% vs. 23.1% in other forms of PH). In this subgroup, left atrial dilatation, increase of pulmonary capillary wedge pressure, PAP and RAP were more pronounced in AF than in SR, suggesting that more marked backward failure led to AF in this setting.
  
  
  CONCLUSIONS
  PH is associated with increased prevalence of AF. Occurrence of AF in PH indicates clinical deterioration and more advanced disease.
authors.affiliation: Department of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria. dennis.rottlaender@uk-koeln.de
authors.forename: Dennis
authors.initials: D
authors.lastname: Rottlaender
authors.forename: Lukas J
authors.initials: LJ
authors.lastname: Motloch
authors.forename: Daniela
authors.initials: D
authors.lastname: Schmidt
authors.forename: Sara
authors.initials: S
authors.lastname: Reda
authors.forename: Robert
authors.initials: R
authors.lastname: Larbig
authors.forename: Martin
authors.initials: M
authors.lastname: Wolny
authors.forename: Daniel
authors.initials: D
authors.lastname: Dumitrescu
authors.forename: Stephan
authors.initials: S
authors.lastname: Rosenkranz
authors.forename: Erland
authors.initials: E
authors.lastname: Erdmann
authors.forename: Uta C
authors.initials: UC
authors.lastname: Hoppe
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications* / Q000503:physiopathology; D016279:Atrial Function, Left; D006328:Cardiac Catheterization; D004452:Echocardiography; D005080:Exercise Test; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011379:Prognosis; D012189:Retrospective Studies; D016277:Ventricular Function, Left
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain