SESSION TITLE: Predictors of Outcomes in PAH
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Tuesday, October 27, 2015 at 08:45 AM - 10:00 AM
PURPOSE: Pulmonary arterial hypertension (PAH) specific therapy lowers the atrial fibrillation (AF) burden and AF related cardiovascular events compared to the background therapy in the same population. Impact of PAH specific therapy on incidence of AF and related comorbidities in patients with both conditions was evaluated in a community-based, retrospective study. This study is the first to explore the relationship between AF and PAH specific therapy.
METHODS: We evaluated 12 patients with PAH, WHO group 1 or 2 (or 3) with out of proportion, paroxysmal or persistent AF (mean age 75 years; 67% women). AF was confirmed by ECG or permanent pacemaker interrogation. PAH was confirmed by RHC and LHC, if indicated. AF burden before and after initiation of PAH specific therapy was compared. Primary endpoint was percent change in AF burden. Secondary endpoint was hospitalization due to heart failure or symptomatic AF requiring cardioversion. Pearson’s χ² test was used to analyze primary and secondary endpoints. Correlation between AF duration and suppression was tested with Spearman rank correlation. Pearson correlation coefficient was used to test the effect of hemodynamic variables on AF suppression
RESULTS: Average baseline NYHA class was 3.5, average CHADS score was 3.2. WHO group classification was: 8 patients in group 1, 4 patients in group 2 or 3 with out of proportion PAH. Prior to PAH specific therapy, mean PA pressure was 36 mmHg, average PVR was 6 Wood units, RA was 10 mmHg, CI was 1.81 L/min/m2, average AF duration was 3 years. Antiarrythmic drugs were used 10 patients; anticoagulants were used in all patients. Prior to PAH specific therapy there were 47 episodes of AF, 23 with hospitalization. After PAH specific therapy there were 12 AF episodes, 5 of which were hospitalized for heart failure and/or cardioversion. Primary and secondary end points were reached with a statistically significant p values of <0.001 and <0.001, respectively. NYHA class improved from average 3.5 to 2.8. There was no correlation between baseline hemodynamics and AF suppression.
CONCLUSIONS: Comorbid coexistence of AF with PAH is associated with poor functional status and frequent symptoms. PAH specific therapy seems to decrease recurrences of AF in a group of patients at high risk for AF recurrences and AF related events independent of AF duration, antiarrythmic therapy and baseline hemodynamic status.
CLINICAL IMPLICATIONS: PAH specific therapy could have beneficial effect on lowering recurrences of AF in patients with both conditions.
DISCLOSURE: The following authors have nothing to disclose: Demir Baykal, Gorica Malisanovic
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