Background: The association between atrial fibrillation (AF) and elevated pulmonary artery pressure (PASP) is poorly defined. We hypothesized that non-valvular AF is an important and independent factor associated with higher PASP.
Methods: The study group included 2576 consecutive patients (age ≥ 50 years), in whom PASP was estimated by trans-thoracic echocardiography during a 12 month period. Patients with left sided prosthetic valve; ≥ moderate aortic stenosis or regurgitation; ≥ moderate mitral regurgitation; mitral stenosis of any degree were excluded, so were patients with heart rhythm other than normal sinus (NSR) or AF. The association between AF and elevated PASP was determined.
Results: Heart rhythm was AF in 253 patients (9.8%). Compared to patients with NSR, patients with AF were older (76±9 vs 67±10 years; p<0.001), had lower left ventricular (LV) ejection fraction (EF) (57%±12 vs 60±11; P<0.001) and higher LV mass (178±57 vs 167±51 grams; p<0.001). Left atrial (LA) diameter was significantly larger (5.1±1.9 vs 4.4±2.3 cm; P<0.001). There was no gender difference between the two groups (Male sex 44% vs 48% p=0.25). PASP was significantly higher in patients with AF (43±14 vs 36±12 mmHg; P<0.001) and significant pulmonary hypertension (PHT), defined as PASP ≥ 50 mmHg, was evident in 77 (30.4%) patients with AF compared to 274 (11.8%) in the group of patients with NSR (P<0.001). By multivariate linear regression, AF was independently associated with higher PASP adjusting for age, gender, LVEF, LV mass and LA diameter. By multivariate logistic analysis, AF was an independent factor associated with PHT adjusting for age, gender and LV mass (Table).
Conclusions: PASP is higher in patients with non-valvular AF compared to patients with NSR. AF emerged as an independent factor associated with elevated PASP and PHT.
