Supplementary Material for: Impact of Pulmonary Hypertension Hemodynamic Phenotype on Incident Atrial Fibrillation

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 post-capillary PH, although AF also occurs among patients with pre-capillary 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 (RHC) 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: pre-capillary (64.9%) and post-capillary (35.1%). The median age was 59.5 years (Q1: 48.4, Q3: 68.4), and 72% were female. In crude models, post-capillary 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.引言：心房颤动/心房扑动（Atrial fibrillation/flutter，AF）在肺动脉高压（pulmonary hypertension，PH）患者中较为常见，且与不良临床预后密切相关。研究显示，心房颤动在毛细血管后肺动脉高压患者中更为高发，但亦可出现于毛细血管前肺动脉高压患者群体中。本研究旨在评估肺动脉高压血流动力学表型对肺动脉高压患者新发心房颤动的独立影响。 方法：本研究回顾性纳入1997年至2017年间于佛罗里达州梅奥诊所（Mayo Clinic）肺动脉高压门诊就诊的262例连续入组患者，所有受试者既往均无房性心律失常诊断史，且均接受了右心导管检查（right heart catheterization，RHC）与超声心动图检查，随访至2021年以评估临床结局。采用Kaplan-Meier分析与Cox比例风险回归模型，评估肺动脉高压血流动力学表型对新发心房颤动的独立影响效应。 结果：本研究队列被划分为两大类肺动脉高压血流动力学表型组：毛细血管前组（64.9%）与毛细血管后组（35.1%）。受试者中位年龄为59.5岁（四分位距Q1：48.4，Q3：68.4），其中72%为女性。在单因素分析模型中，毛细血管后肺动脉高压与新发心房颤动呈显著正相关（风险比HR=2.17，95%置信区间CI：1.26–3.74，P=0.005）。经多变量校正后，该相关性不再具有统计学意义，而左心房容积指数仍与新发心房颤动存在独立关联（校正后风险比aHR=1.30，95%CI：1.09–1.54，P=0.003）。 结论：在本研究的患者样本中，肺动脉高压血流动力学表型与新发心房颤动无显著相关性，但超声心动图提示的左心房重构似乎对心房颤动的发生发展具有更显著的影响。未来需开展更大规模的研究以验证本研究发现，并明确该人群心房颤动潜在的可干预危险因素。