{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T15:02:55Z","timestamp":1785250975415,"version":"3.55.0"},"reference-count":19,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2026,5,5]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">The relationship between right atrial (RA) structural and functional remodeling and risk of incident atrial fibrillation\/flutter (AF\/AFL) in pulmonary arterial hypertension remains poorly defined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">In a multicenter observational cohort study of 326 patients with pulmonary arterial hypertension, we evaluated associations between RA structure and function, as determined by echocardiography, and incident AF\/AFL. Incidence rates were calculated using time\u2010to\u2010event analysis. Cox proportional hazards models identified factors associated with incident AF\/AFL, and Harrell's C\u2010statistics compared predictive performance. Survival decision tree and restricted cubic spline analyses identified thresholds associated with increased risk of AF\/AFL.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      The mean age was 51\u00b115\u2009years, 79% were women, and the mean REVEAL (Registry to Evaluate Early and Long\u2010Term Outcomes in Pulmonary Arterial Hypertension) Lite score was 7.4\u00b12.9. Over a median follow\u2010up of 6.1\u2009years, 56 patients (17.1%) developed AF\/AFL, corresponding to an incidence rate of 25.3 cases (95% CI, 19.5\u201332.8) per 1000 person\u2010years. Each 5% decrease in RA emptying fraction (hazard ratio [HR], 1.38 [95% CI, 1.03\u20131.86];\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.03) and each 1\u2010cm increase in right ventricular basal diameter (HR, 1.55 [95% CI, 1.18\u20132.05];\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.002) were independently associated with 38% and 55% higher hazards of incident AF\/AFL, respectively. The C\u2010statistics for predicting incident AF\/AFL were 0.62 for RA emptying fraction and 0.65 for right ventricular basal diameter. Survival decision tree and restricted cubic spline analyses identified thresholds for right ventricular basal diameter (\u22655.4 cm) and RA emptying fraction (&lt;17% and &lt;45%) associated with increased AF\/AFL risk.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Larger right ventricular basal diameter and lower RA emptying fraction are associated with increased risk of incident AF\/AFL in patients with pulmonary arterial hypertension and may help identify individuals at higher risk.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.125.045587","type":"journal-article","created":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T09:58:36Z","timestamp":1776679116000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Incident Atrial Fibrillation and Flutter in Patients With Pulmonary Arterial Hypertension: Influence of Right Ventricular Dilatation and Reduced Right Atrial Function"],"prefix":"10.1161","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-9424-5301","authenticated-orcid":false,"given":"Danny","family":"Mohama","sequence":"first","affiliation":[{"name":"University of Minnesota","place":["Minneapolis, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3342-4630","authenticated-orcid":false,"given":"Pitchaya","family":"Worapongsatitaya","sequence":"additional","affiliation":[{"name":"University of Minnesota","place":["Minneapolis, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-3499-6902","authenticated-orcid":false,"given":"Bettia","family":"Celestin","sequence":"additional","affiliation":[{"name":"Stanford University","place":["Palo Alto, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8998-7259","authenticated-orcid":false,"given":"Felipe","family":"Kazmirczak","sequence":"additional","affiliation":[{"name":"University of Minnesota","place":["Minneapolis, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3928-7080","authenticated-orcid":false,"given":"Shadi P.","family":"Bagherzadeh","sequence":"additional","affiliation":[{"name":"Stanford University","place":["Palo Alto, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-4960-6764","authenticated-orcid":false,"given":"Veronica","family":"Daniel","sequence":"additional","affiliation":[{"name":"University of Minnesota","place":["Minneapolis, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0364-6742","authenticated-orcid":false,"given":"Kurt W.","family":"Prins","sequence":"additional","affiliation":[{"name":"Medical University of South Carolina","place":["Charleston, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9059-0635","authenticated-orcid":false,"given":"Sasha Z.","family":"Prisco","sequence":"additional","affiliation":[{"name":"University of Minnesota","place":["Minneapolis, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6538-4143","authenticated-orcid":false,"given":"E. Kenneth","family":"Weir","sequence":"additional","affiliation":[{"name":"University of Minnesota","place":["Minneapolis, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1106-3202","authenticated-orcid":false,"given":"Stephen L.","family":"Archer","sequence":"additional","affiliation":[{"name":"Queen\u2019s University","place":["Kingston, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0734-0994","authenticated-orcid":false,"given":"Roham","family":"Zamanian","sequence":"additional","affiliation":[{"name":"Stanford University","place":["Palo Alto, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9648-7671","authenticated-orcid":false,"given":"Francois","family":"Haddad","sequence":"additional","affiliation":[{"name":"Stanford University","place":["Palo Alto, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6210-0467","authenticated-orcid":false,"given":"Thenappan","family":"Thenappan","sequence":"additional","affiliation":[{"name":"University of Minnesota","place":["Minneapolis, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.j5492"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.01900-2018"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.01454-2021"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2016.11.003"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2014.07.079"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2012.06.024"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1177\/2045894018769874"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1177\/2045894018790316"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2014.10.003"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2019.02.004"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.122.027559"},{"key":"e_1_3_1_13_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.14874"},{"key":"e_1_3_1_14_2","doi-asserted-by":"publisher","DOI":"10.1002\/ehf2.14124"},{"key":"e_1_3_1_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2022.05.004"},{"key":"e_1_3_1_16_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12968-020-00631-1"},{"key":"e_1_3_1_17_2","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.01696-2023"},{"key":"e_1_3_1_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2019.06.066"},{"key":"e_1_3_1_19_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8167.2011.02255.x"},{"key":"e_1_3_1_20_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0238002"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.125.045587","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T14:47:27Z","timestamp":1785250047000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.125.045587"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,5]]},"references-count":19,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,5,5]]}},"alternative-id":["10.1161\/JAHA.125.045587"],"URL":"https:\/\/doi.org\/10.1161\/jaha.125.045587","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,5]]},"assertion":[{"value":"2025-08-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-04","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-20","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e045587"}}