title: Supraventricular Arrhythmias in Patients With Pulmonary Arterial Hypertension.
abstract: 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.
authors.affiliation: Division of Cardiology, University of Turin, Città Della Salute e Della Scienza, Turin, Italy. Electronic address: margheritacannillo@gmail.com.
authors.forename: Margherita
authors.initials: M
authors.lastname: Cannillo
authors.affiliation: Division of Cardiology, University of Turin, Città Della Salute e Della Scienza, Turin, Italy.
authors.forename: Walter
authors.initials: W
authors.lastname: Grosso Marra
authors.affiliation: Division of Cardiology, University of Turin, Città Della Salute e Della Scienza, Turin, Italy.
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Gili
authors.affiliation: Division of Cardiology, University of Turin, Città Della Salute e Della Scienza, Turin, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: D'Ascenzo
authors.affiliation: Division of Cardiology, University of Turin, Città Della Salute e Della Scienza, Turin, Italy.
authors.forename: Mara
authors.initials: M
authors.lastname: Morello
authors.affiliation: Division of Pneumology, Città Della Salute e Della Scienza, Turin, Italy.
authors.forename: Lorena
authors.initials: L
authors.lastname: Mercante
authors.affiliation: Division of Cardiology, University of Turin, Città Della Salute e Della Scienza, Turin, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Mistretta
authors.affiliation: Division of Cardiology, University of Turin, Città Della Salute e Della Scienza, Turin, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Salera
authors.affiliation: Division of Cardiology, University of Turin, Città Della Salute e Della Scienza, Turin, Italy.
authors.forename: Domenica
authors.initials: D
authors.lastname: Zema
authors.affiliation: Division of Cardiology, University of Turin, Città Della Salute e Della Scienza, Turin, Italy.
authors.forename: Arianna
authors.initials: A
authors.lastname: Bissolino
authors.affiliation: Division of Rheumatology, Città Della Salute e Della Scienza, Turin, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Fusaro
authors.affiliation: Division of Rheumatology, Città Della Salute e Della Scienza, Turin, Italy; Division of Cardiology, Città Della Salute e Della Scienza, Turin, Italy.
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Marra
authors.affiliation: Division of Pneumology, Città Della Salute e Della Scienza, Turin, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Libertucci
authors.affiliation: Division of Cardiology, University of Turin, Città Della Salute e Della Scienza, Turin, Italy.
authors.forename: Fiorenzo
authors.initials: F
authors.lastname: Gaita
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications* / Q000503:physiopathology; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013617:Tachycardia, Supraventricular / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology