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Clinical impact of atrial fibrillation in patients with pulmonary hypertension.

Rottlaender D, Motloch LJ, Schmidt D, Reda S, Larbig R, Wolny M, Dumitrescu D, Rosenkranz S, Erdmann E, Hoppe UC - PLoS ONE (2012)

Bottom Line: Pulmonary hypertension (PH) is associated with progressive impairment of right ventricular function, reduced exercise capacity and a poor prognosis.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 PH due to left heart failure the prevalence of AF was particularly high (57.7% vs. 23.1% in other forms of PH).

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria. dennis.rottlaender@uk-koeln.de

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.

Conclusion: PH is associated with increased prevalence of AF. Occurrence of AF in PH indicates clinical deterioration and more advanced disease.

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Related in: MedlinePlus

Laboratory parameters and exercise capacity in PH with and without AF.NT-pro-BNP, estimated glomerular filtration rate (eGFR), urea nitrogen (BUN) and 6-minute walk distance of patients with PH were compared in those with AF (PH-AF) and SR (PH-SR). * p<0.05. Error bars representing standard error of mean.
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pone-0033902-g001: Laboratory parameters and exercise capacity in PH with and without AF.NT-pro-BNP, estimated glomerular filtration rate (eGFR), urea nitrogen (BUN) and 6-minute walk distance of patients with PH were compared in those with AF (PH-AF) and SR (PH-SR). * p<0.05. Error bars representing standard error of mean.

Mentions: Thus far, clinical manifestation of AF in PH has not been analyzed systematically. Therefore, we evaluated functional class, exercise capacity, and laboratory parameters indicative of hemodynamic status in this population. The clinical condition in patients with AF in PH was more severe than in patients without AF, as indicated by the NYHA/WHO functional class (table 2). Consistently, the 6-minute walk distance was significantly shorter in the PH-AF group (PH-SR vs. PH-AF: 355.55±9.86 m, n = 130 vs. 321.98±14.1 m, n = 53; p<0.05, figure 1). Moreover, in patients with AF, the elevation of NT-proBNP serum levels was more pronounced (PH-SR vs. PH-AF: 2128.88±429.97 ng/l, n = 155 vs. 3252.79±401.76 ng/l, n = 70; p<0.05, figure 1).


Clinical impact of atrial fibrillation in patients with pulmonary hypertension.

Rottlaender D, Motloch LJ, Schmidt D, Reda S, Larbig R, Wolny M, Dumitrescu D, Rosenkranz S, Erdmann E, Hoppe UC - PLoS ONE (2012)

Laboratory parameters and exercise capacity in PH with and without AF.NT-pro-BNP, estimated glomerular filtration rate (eGFR), urea nitrogen (BUN) and 6-minute walk distance of patients with PH were compared in those with AF (PH-AF) and SR (PH-SR). * p<0.05. Error bars representing standard error of mean.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3306317&req=5

pone-0033902-g001: Laboratory parameters and exercise capacity in PH with and without AF.NT-pro-BNP, estimated glomerular filtration rate (eGFR), urea nitrogen (BUN) and 6-minute walk distance of patients with PH were compared in those with AF (PH-AF) and SR (PH-SR). * p<0.05. Error bars representing standard error of mean.
Mentions: Thus far, clinical manifestation of AF in PH has not been analyzed systematically. Therefore, we evaluated functional class, exercise capacity, and laboratory parameters indicative of hemodynamic status in this population. The clinical condition in patients with AF in PH was more severe than in patients without AF, as indicated by the NYHA/WHO functional class (table 2). Consistently, the 6-minute walk distance was significantly shorter in the PH-AF group (PH-SR vs. PH-AF: 355.55±9.86 m, n = 130 vs. 321.98±14.1 m, n = 53; p<0.05, figure 1). Moreover, in patients with AF, the elevation of NT-proBNP serum levels was more pronounced (PH-SR vs. PH-AF: 2128.88±429.97 ng/l, n = 155 vs. 3252.79±401.76 ng/l, n = 70; p<0.05, figure 1).

Bottom Line: Pulmonary hypertension (PH) is associated with progressive impairment of right ventricular function, reduced exercise capacity and a poor prognosis.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 PH due to left heart failure the prevalence of AF was particularly high (57.7% vs. 23.1% in other forms of PH).

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria. dennis.rottlaender@uk-koeln.de

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.

Conclusion: PH is associated with increased prevalence of AF. Occurrence of AF in PH indicates clinical deterioration and more advanced disease.

Show MeSH
Related in: MedlinePlus