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Semin Thromb Hemost 2020; 46(08): 887-894
DOI: 10.1055/s-0040-1718397
Review Article

New-Onset Atrial Fibrillation and Adverse In-Hospital Outcome in Patients with Acute Pulmonary Embolism

Ri-Bo Tang   *
1   Department of Cardiology, Beijing An zhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing, People's Republic of China
,
Yan-Yan Jing‡   *
2   Department of Cardiology, Yantai Yuhuangding Hospital, Qingdao University, Shandong Province, People's Republic of China
,
Zhi-Yuan Xu
1   Department of Cardiology, Beijing An zhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing, People's Republic of China
2   Department of Cardiology, Yantai Yuhuangding Hospital, Qingdao University, Shandong Province, People's Republic of China
,
Jian-Zeng Dong
1   Department of Cardiology, Beijing An zhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing, People's Republic of China
,
Xin Du
1   Department of Cardiology, Beijing An zhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing, People's Republic of China
,
Jia-Hui Wu
1   Department of Cardiology, Beijing An zhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing, People's Republic of China
,
Rong-Hui Yu
1   Department of Cardiology, Beijing An zhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing, People's Republic of China
,
De-Yong Long
1   Department of Cardiology, Beijing An zhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing, People's Republic of China
,
Man Ning
1   Department of Cardiology, Beijing An zhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing, People's Republic of China
,
Cai-Hua Sang
1   Department of Cardiology, Beijing An zhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing, People's Republic of China
,
Chen-Xi Jiang
1   Department of Cardiology, Beijing An zhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing, People's Republic of China
,
Rong Bai
1   Department of Cardiology, Beijing An zhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing, People's Republic of China
,
Nian Liu
1   Department of Cardiology, Beijing An zhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing, People's Republic of China
,
Song-Nan Wen
1   Department of Cardiology, Beijing An zhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing, People's Republic of China
,
Song-Nan Li
1   Department of Cardiology, Beijing An zhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing, People's Republic of China
,
Xuan Chen
1   Department of Cardiology, Beijing An zhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing, People's Republic of China
,
Shu-Tao Huang
1   Department of Cardiology, Beijing An zhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing, People's Republic of China
,
Yi-Kai Cui
1   Department of Cardiology, Beijing An zhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing, People's Republic of China
,
Chang-Sheng Ma
1   Department of Cardiology, Beijing An zhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing, People's Republic of China
› Author Affiliations Funding This study was supported by the National Key Research and Development Program of China (2017YFC0908803, 2017YFC0908800, and 2018YFC1312501) and Beijing Municipal Science and Technology Commission (No. Z181100001718105).
› Further Information
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Abstract

Atrial fibrillation (AF) can be secondary to acute pulmonary embolism (PE). This study aimed to investigate the prognostic impact of new-onset AF on patients with acute PE. In this study, 4,288 consecutive patients who were diagnosed with acute PE were retrospectively screened. In total, 77 patients with acute PE and new-onset AF were analyzed. Another 154 acute PE patients without AF were selected as the age- and sex-matched control group. Adverse in-hospital outcome comprised one of the following conditions: all-cause death, endotracheal intubation, cardiopulmonary resuscitation, and intravenous catecholamine therapy. The patients with new-onset AF had higher prevalence of congestive heart failure, higher simplified PE severity index (sPESI), higher creatinine, and larger left atrium diameter. The incidences of adverse in-hospital outcomes were 10.4 and 2.6% in patients with new-onset AF and no AF, respectively (p = 0.02). Patients with sPESI ≥ 1 had higher incidence of adverse in-hospital outcomes than those with sPESI = 0 (9.4 vs. 0.9%, p < 0.01). The area under the receiver operating characteristic curve of sPESI and sPESI + AF (adding 1 point for new-onset AF) scores in assessing the adverse in-hospital outcome were 0.80 (95% confidence interval [CI]: 0.68–0.93) and 0.84 (95% CI: 0.72–0.96), respectively. In multivariable analysis, sPESI ≥ 1 (odds ratio, 8.88; 95% CI: 1.10–72.07; p = 0.04) was an independent predictor of adverse in-hospital outcome. However, new-onset AF was not an independent predictor. In the population studied, sPESI is an independent predictor of adverse in-hospital outcomes, whereas new-onset AF following acute PE is not, but it may add predictive value to sPESI.

Keywords

pulmonary embolism - PE - atrial fibrillation - AF - prognosis

Role of Sponsors

The sponsor had no role in the design of the study, the collection and analysis of the data, or the preparation of the manuscript.


* Ri-Bo Tang and Yan-Yan Jing contributed equally and share the first authorship.




Publication History

Article published online:
23 December 2020

© 2020. Thieme. All rights reserved.

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  • References

  • 1 Giuntini C, Di Ricco G, Marini C, Melillo E, Palla A. Pulmonary embolism: epidemiology. Chest 1995; 107 (1, Suppl): 3S-9S
    CrossrefPubMedGoogle Scholar
  • 2 White RH. The epidemiology of venous thromboembolism. Circulation 2003; 107 (23) (Suppl. 01) I4-I8
    PubMedGoogle Scholar
  • 3 Lloyd-Jones DM, Wang TJ, Leip EP. et al. Lifetime risk for development of atrial fibrillation: the Framingham Heart Study. Circulation 2004; 110 (09) 1042-1046
    CrossrefPubMedGoogle Scholar
  • 4 Bikdeli B, Abou Ziki MD, Lip GYH. Pulmonary embolism and atrial fibrillation: two sides of the same coin? A systematic review. Semin Thromb Hemost 2017; 43 (08) 849-863
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Yasuoka Y, Naito J, Hirooka K. et al. Right atrial spontaneous echo contrast indicates a high incidence of perfusion defects in pulmonary scintigraphy in patients with atrial fibrillation. Heart Vessels 2009; 24 (01) 32-36
    CrossrefPubMedGoogle Scholar
  • 6 Ng AC, Adikari D, Yuan D. et al. The prevalence and incidence of atrial fibrillation in patients with acute pulmonary embolism. PLoS One 2016; 11 (03) e0150448
    CrossrefPubMedGoogle Scholar
  • 7 Tang RB, Xu ZY, Avula UMR. et al. Risk stratification for acute pulmonary embolism in patients with atrial fibrillation: role of CHADS2 score. Semin Thromb Hemost 2017; 43 (08) 864-870
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Jiménez D, Aujesky D, Moores L. et al; RIETE Investigators. Simplification of the pulmonary embolism severity index for prognostication in patients with acute symptomatic pulmonary embolism. Arch Intern Med 2010; 170 (15) 1383-1389
    CrossrefPubMedGoogle Scholar
  • 9 Dellas C, Puls M, Lankeit M. et al. Elevated heart-type fatty acid-binding protein levels on admission predict an adverse outcome in normotensive patients with acute pulmonary embolism. J Am Coll Cardiol 2010; 55 (19) 2150-2157
    CrossrefPubMedGoogle Scholar
  • 10 Şahan E, Şahan S, Karamanlıoğlu M, Gül M, Tüfekçioğlu O. Prediction of new onset atrial fibrillation in patients with acute pulmonary embolism: the role of sPESI score. Turk Kardiyol Dern Ars 2019; 47 (03) 191-197
    PubMedGoogle Scholar
  • 11 Stein PD, Matta F, Goldman J. Obesity and pulmonary embolism: the mounting evidence of risk and the mortality paradox. Thromb Res 2011; 128 (06) 518-523
    CrossrefPubMedGoogle Scholar
  • 12 Basili S, Pacini G, Guagnano MT. et al. Insulin resistance as a determinant of platelet activation in obese women. J Am Coll Cardiol 2006; 48 (12) 2531-2538
    CrossrefPubMedGoogle Scholar
  • 13 Piazza G, Goldhaber SZ. Pulmonary embolism in heart failure. Circulation 2008; 118 (15) 1598-1601
    CrossrefPubMedGoogle Scholar
  • 14 Ko D, Hylek EM. Anticoagulation in the older adult: optimizing benefit and reducing risk. Semin Thromb Hemost 2014; 40 (06) 688-694
    Article in Thieme ConnectPubMedGoogle Scholar
  • 15 Wang CC, Lin CL, Wang GJ, Chang CT, Sung FC, Kao CH. Atrial fibrillation associated with increased risk of venous thromboembolism. A population-based cohort study. Thromb Haemost 2015; 113 (01) 185-192
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Tan Q, Zhang S, Qi X, Zou X, Sun Q. Permanent atrial fibrillation impairs the function of circulating endothelial progenitor cells. Postgrad Med 2017; 129 (02) 198-204
    CrossrefPubMedGoogle Scholar
  • 17 Skalidis EI, Zacharis EA, Tsetis DK. et al. Endothelial cell function during atrial fibrillation and after restoration of sinus rhythm. Am J Cardiol 2007; 99 (09) 1258-1262
    CrossrefPubMedGoogle Scholar
  • 18 Kukla P, McIntyre WF, Koracevic G. et al. Relation of atrial fibrillation and right-sided cardiac thrombus to outcomes in patients with acute pulmonary embolism. Am J Cardiol 2015; 115 (06) 825-830
    CrossrefPubMedGoogle Scholar
  • 19 Lohvinov YM, Mikhaliev KO, Zharinov OJ. Contemporary echocardiographic assessment of atrial appendages in non-valvular atrial fibrillation. Kardiol Pol 2015; 73 (09) 701-710
    CrossrefPubMedGoogle Scholar
  • 20 Bashir M, Asher CR, Garcia MJ. et al. Right atrial spontaneous echo contrast and thrombi in atrial fibrillation: a transesophageal echocardiography study. J Am Soc Echocardiogr 2001; 14 (02) 122-127
    CrossrefPubMedGoogle Scholar
  • 21 Matthews JC, McLaughlin V. Acute right ventricular failure in the setting of acute pulmonary embolism or chronic pulmonary hypertension: a detailed review of the pathophysiology, diagnosis, and management. Curr Cardiol Rev 2008; 4 (01) 49-59
    CrossrefPubMedGoogle Scholar
  • 22 Jabre P, Jouven X, Adnet F. et al. Atrial fibrillation and death after myocardial infarction: a community study. Circulation 2011; 123 (19) 2094-2100
    CrossrefPubMedGoogle Scholar
  • 23 Chamberlain AM, Redfield MM, Alonso A, Weston SA, Roger VL. Atrial fibrillation and mortality in heart failure: a community study. Circ Heart Fail 2011; 4 (06) 740-746
    CrossrefPubMedGoogle Scholar
  • 24 Conen D, Chae CU, Glynn RJ. et al. Risk of death and cardiovascular events in initially healthy women with new-onset atrial fibrillation. JAMA 2011; 305 (20) 2080-2087
    CrossrefPubMedGoogle Scholar
  • 25 Koracevic G, Atanaskovic V, Salinger S. et al. Atrial fibrillation is not a predictor of in-hospital mortality in pulmonary embolism. Eur Respir J 2007; 30: 80
    CrossrefPubMedGoogle Scholar
  • 26 Barra SN, Paiva LV, Providência R, Fernandes A, Leitão Marques A. Atrial fibrillation in acute pulmonary embolism: prognostic considerations. Emerg Med J 2014; 31 (04) 308-312
    CrossrefPubMedGoogle Scholar
  • 27 Krajewska A, Ptaszynska-Kopczynska K, Kiluk I. et al. Paroxysmal atrial fibrillation in the course of acute pulmonary embolism: clinical significance and impact on prognosis. BioMed Res Int 2017; 2017: 5049802
    CrossrefPubMedGoogle Scholar
  • 28 Ebner M, Rogge NIJ, Parwani AS. et al. Atrial fibrillation is frequent but does not affect risk stratification in pulmonary embolism. J Intern Med 2020; 287 (01) 100-113
    CrossrefPubMedGoogle Scholar
  • 29 Yang Y, Liu B, Taylor J. et al. Prevalence and clinical impact of atrial fibrillation in patients with pulmonary embolism. South Med J 2020; 113 (02) 93-97
    CrossrefPubMedGoogle Scholar