INTRODUCTION Atrial fibrillation/flutter (AF) is common among patients with pulmonary hypertension (PH) and is associated with poor clinical outcomes. AF has been shown to occur more commonly among patients with postcapillary PH, although AF also occurs among patients with precapillary PH. The goal of this study was to evaluate the independent impact of PH hemodynamic phenotype on incident AF among patients with PH. METHODS We retrospectively identified 262 consecutive patients, without a prior diagnosis of atrial arrhythmias, seen at the PH clinic at Mayo Clinic, Florida, between 1997 and 2017, who had right heart catheterization and echocardiography performed, with follow-up for outcomes through 2021. Kaplan-Meier analysis and Cox-proportional hazards regression modeling were used to evaluate the independent effect of PH hemodynamic phenotype on incident AF. RESULTS Our study population was classified into two broad PH hemodynamic groups: precapillary (64.9%) and postcapillary (35.1%). The median age was 59.5 years (Q1: 48.4, Q3: 68.4), and 72% were female. In crude models, postcapillary PH was significantly associated with incident AF (HR 2.17, 95% CI: 1.26-3.74, p = 0.005). This association was lost following multivariable adjustment, whereas left atrial volume index remained independently associated with incident AF (aHR 1.30, 95% CI: 1.09-1.54, p = 0.003). CONCLUSION We found PH hemodynamic phenotype was not significantly associated with incident AF in our patient sample; however, echocardiographic evidence of left atrial remodeling appeared to have a greater impact on AF development. Larger studies are needed to validate these findings and identify potential modifiable risk factors for AF in this population.

中文翻译：

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肺动脉高压血流动力学表型对心房颤动的影响。

简介 心房颤动/扑动 (AF) 在肺动脉高压 (PH) 患者中很常见，并且与不良的临床结果相关。AF 已被证明更常见于毛细血管后 PH 患者，尽管 AF 也发生在毛细血管前 PH 患者中。本研究的目的是评估 PH 血流动力学表型对 PH 患者 AF 事件的独立影响。方法 我们回顾性地确定了 1997 年至 2017 年间在佛罗里达州梅奥诊所 PH 诊所就诊的 262 名连续患者，这些患者之前没有诊断出房性心律失常，接受了右心导管插入术和超声心动图检查，并随访至 2021 年的结果。 Kaplan-Meier 分析和 Cox 比例风险回归模型用于评估 PH 血流动力学表型对 AF 事件的独立影响。结果 我们的研究人群分为两大类 PH 血流动力学组：毛细血管前组 (64.9%) 和毛细血管后组 (35.1%)。中位年龄为 59.5 岁（第一季度：48.4 岁，第三季度：68.4 岁），其中 72% 为女性。在原始模型中，毛细血管后 PH 与 AF 发生显着相关（HR 2.17，95% CI：1.26-3.74，p = 0.005）。经过多变量调整后，这种关联消失了，而左心房容积指数仍然与 AF 事件独立相关（aHR 1.30，95% CI：1.09-1.54，p = 0.003）。结论 我们发现，在我们的患者样本中，PH 血流动力学表型与 AF 事件没有显着相关性；然而，左心房重构的超声心动图证据似乎对房颤的发展有更大的影响。需要更大规模的研究来验证这些发现并确定该人群中房颤的潜在可改变危险因素。