title: Incidence, predictors, and clinical course of atrial tachyarrhythmias in patients with pulmonary hypertension.
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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: 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.
authors.forename: Arun
authors.initials: A
authors.lastname: Kanmanthareddy
authors.forename: Yeruva Madhu
authors.initials: YM
authors.lastname: Reddy
authors.forename: Hemant
authors.initials: H
authors.lastname: Boolani
authors.forename: Sowjanya
authors.initials: S
authors.lastname: Duthuluru
authors.forename: Jayasree
authors.initials: J
authors.lastname: Pillarisetti
authors.forename: Ajay
authors.initials: A
authors.lastname: Vallakati
authors.forename: Sudharani
authors.initials: S
authors.lastname: Bommana
authors.forename: Donita
authors.initials: D
authors.lastname: Atkins
authors.forename: Timothy
authors.initials: T
authors.lastname: Williamson
authors.forename: Dhanunjaya
authors.initials: D
authors.lastname: Lakkireddy
mesh_terms: D001145:Arrhythmias, Cardiac / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology*; D006328:Cardiac Catheterization; D004452:Echocardiography; D005260:Female; D006325:Heart Atria / Q000503:physiopathology*; D006439:Hemodynamics; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors