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Miao L, Shi J, Yu H, Song L, Zhu C, Shi D, Gao J. Studies on Atrial Fibrillation and Venous Thromboembolism in the Past 20 Years: A Bibliometric Analysis Via CiteSpace and VOSviewer. J Am Heart Assoc 2023; 12:e029810. [PMID: 37586071 PMCID: PMC10547310 DOI: 10.1161/jaha.123.029810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
The conjunction of atrial fibrillation (AF) and venous thromboembolism (VTE) is common in clinical practice. Over the last 2 decades, a significant number of articles (2500) have been published about AF and VTE. To effectively analyze and present these vast amounts of information, this study uses bibliometric research methods to categorize and consolidate these publications. The number of publications has increased yearly, especially since 2012. The United States was the most prolific country, with 1054 studies published. The most productive institution was McMaster University. Gregory Y.H. Lip was the most prolific author. The keyword analysis identified that the research focuses from 2003 to 2014 were factor Xa inhibitor, dabigatran etexilate, direct thrombin inhibitor, double-blind, deep vein thrombosis, molecular weight heparin, stroke prevention, etc. From 2015 to 2016, research mainly focused on venous thromboembolism, antithrombotic therapy, anticoagulant, warfarin, atrial fibrillation, stroke, and pulmonary embolism. Studies during 2017 to 2022 focused on apixaban, direct oral anticoagulant, rivaroxaban, dabigatran, hemorrhage, edoxaban, medicine efficacy and safety, risk factors, clinical management, and vitamin K antagonists. Since 2018, novel oral anticoagulants have been the most commonly used keywords. On the whole, most studies of AF and VTE focus on pathogenesis and therapeutic drugs. The causal relationship between AF and VTE, the effectiveness and safety of novel oral anticoagulants in the treatments, the anticoagulant regimen of AF and VTE co-disease, and the treatment regimen for vulnerable populations such as the elderly or obese people were the focus of current research and will continue to be the central point of future research.
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Affiliation(s)
- Lina Miao
- Xiyuan Hospital, China Academy of Chinese Medical SciencesBeijingChina
| | - Junhe Shi
- Xiyuan Hospital, China Academy of Chinese Medical SciencesBeijingChina
| | - Haixu Yu
- Beijing Jishuitan HospitalBeijingChina
| | - Lei Song
- Xiyuan Hospital, China Academy of Chinese Medical SciencesBeijingChina
| | - Chunlin Zhu
- Xiyuan Hospital, China Academy of Chinese Medical SciencesBeijingChina
| | - Dazhuo Shi
- Xiyuan Hospital, China Academy of Chinese Medical SciencesBeijingChina
- Cardiovascular Diseases Center, Xiyuan Hospital, China Academy of Chinese Medical SciencesBeijingChina
| | - Jie Gao
- Xiyuan Hospital, China Academy of Chinese Medical SciencesBeijingChina
- Cardiovascular Diseases Center, Xiyuan Hospital, China Academy of Chinese Medical SciencesBeijingChina
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Djuric I, Dzudovic B, Subotic B, Dzudovic J, Matijasevic J, Benic M, Salinger S, Mitevska I, Kos L, Kovacevic-Preradovic T, Simovic S, Miloradovic V, Savicic T, Bozovic B, Bulatovic N, Kafedzic S, Neskovic AN, Kocev N, Marinković J, Obradovic S. New-Onset Paroxysmal Atrial Fibrillation in the Setting of Acute Pulmonary Embolism Is Associated with All-Cause Hospital Mortality in Women but Not in Men. Diagnostics (Basel) 2023; 13:diagnostics13111829. [PMID: 37296681 DOI: 10.3390/diagnostics13111829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/24/2023] [Accepted: 05/06/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Patients with acute pulmonary embolism (PE) may have various types of atrial fibrillation (AF). The role of AF in hemodynamic states and outcomes may differ between men and women. METHODS In total, 1600 patients (743 males and 857 females) with acute PE were enrolled in this study. The severity of PE was assessed using the European Society of Cardiology (ESC) mortality risk model. Patients were allocated into three groups according to their electrocardiography recordings taken during hospitalization: sinus rhythm, new-onset paroxysmal AF, and persistent/permanent AF. The association between the types of AF and all-cause hospital mortality was tested using regression models and net reclassification index (NRI) and integrated discrimination index (IDI) statistics with respect to sex. RESULTS There were no differences between the frequencies of the types of AF between men and women: 8.1% vs. 9.1% and 7.5% vs. 7.5% (p = 0.766) for paroxysmal and persistent/permanent AF, respectively. We found that the rates of paroxysmal AF significantly increased across the mortality risk strata in both sexes. Among the types of AF, the presence of paroxysmal AF had a predictive value for all-cause hospital mortality independent of mortality risk and age in women only (adjusted HR, 2.072; 95% CI, 1.274-3.371; p = 0.003). Adding paroxysmal AF to the ESC risk model did not improve the reclassification of patient risk for the prediction of all-cause mortality, but instead enhanced the discriminative power of the existing model in women only (NRI, not significant; IDI, 0.022 (95% CI, 0.004-0.063); p = 0.013). CONCLUSION The occurrence of paroxysmal AF in female patients with acute PE has predictive value for all-cause hospital mortality independent of age and mortality risk.
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Affiliation(s)
- Ivica Djuric
- Clinic of Cardiology, Military Medical Academy, 11000 Belgrade, Serbia
| | - Boris Dzudovic
- Clinic of Emergency Internal Medicine, Military Medical Academy, 11000 Belgrade, Serbia
- School of Medicine Military Medical Academy, University of Defense, 11000 Belgrade, Serbia
| | - Bojana Subotic
- Clinic of Cardiology, Military Medical Academy, 11000 Belgrade, Serbia
| | - Jelena Dzudovic
- National Poison Control Center, Military Medical Academy, 11000 Belgrade, Serbia
| | - Jovan Matijasevic
- Institute for Pulmonary Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
- School of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Marija Benic
- Institute for Pulmonary Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Sonja Salinger
- Clinic of Cardiology, Clinical Center Nis, University of Nis, 18000 Nis, Serbia
| | - Irena Mitevska
- Clinic of Cardiology, School of Medicine, University of Skopje, 1000 Skopje, North Macedonia
| | - Ljiljana Kos
- Clinic of Cardiology, Clinical Center Banja Luka, School of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina
| | - Tamara Kovacevic-Preradovic
- Clinic of Cardiology, Clinical Center Banja Luka, School of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina
| | - Stefan Simovic
- Clinic of Cardiology, Clinical Center Kragujevac, School of Medicine, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Vladimir Miloradovic
- Clinic of Cardiology, Clinical Center Kragujevac, School of Medicine, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Tanja Savicic
- Department for Internal Medicine, General Hospital Pancevo, 26000 Pancevo, Serbia
| | - Bjanka Bozovic
- Clinic of Cardiology, Clinical Center Podgorica, 81000 Podgorica, Montenegro
| | - Nebojsa Bulatovic
- Clinic of Cardiology, Clinical Center Podgorica, 81000 Podgorica, Montenegro
- School of Medicine Podgorica, University of Podgorica, 81000 Podgorica, Montenegro
| | - Srdjan Kafedzic
- Department of Cardiology, Clinical Hospital Center Zemun, 11080 Zemun, Serbia
| | - Aleksandar N Neskovic
- Department of Cardiology, Clinical Hospital Center Zemun, 11080 Zemun, Serbia
- School of Medicine Belgrade, University of Belgrade, 11000 Beograd, Serbia
| | - Nikola Kocev
- Institute for Medical Statistics School of Medicine, University of Belgrade, 11000 Beograd, Serbia
| | - Jelena Marinković
- Institute for Medical Statistics School of Medicine, University of Belgrade, 11000 Beograd, Serbia
| | - Slobodan Obradovic
- Clinic of Cardiology, Military Medical Academy, 11000 Belgrade, Serbia
- School of Medicine Military Medical Academy, University of Defense, 11000 Belgrade, Serbia
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Kanuri SH, Jayesh Sirrkay P, Ulucay AS. COVID-19 HEART unveiling as atrial fibrillation: pathophysiology, management and future directions for research. Egypt Heart J 2023; 75:36. [PMID: 37120772 PMCID: PMC10149046 DOI: 10.1186/s43044-023-00359-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/22/2023] [Indexed: 05/01/2023] Open
Abstract
BACKGROUND COVID-19 infections are known to cause numerous systemic complications including cardiovascular disorders. In this regard, clinicians recently noticed that patients recovering from COVID-19 infections presented with diverse set of cardiovascular disorders in addition to those admitted to ICU (intensive care unit). COVID-19 heart has multifaceted presentation ranging from dysrhythmias, myocarditis, stroke, coronary artery disease, thromboembolism to heart failure. Atrial fibrillation is the most common cardiac arrhythmia among COVID-19 patients. In the background section, we briefly discussed epidemiology and spectrum of cardiac arrhythmias in COVID-19 patients. MAIN BODY In this state-of-the-art review we present here, we present the information regarding COVID-19-induced A-fib in sections, namely mechanism of action, clinical presentation, diagnosis and treatment. Unfortunately, its occurrence significantly increases the mortality and morbidity with a potential risk of complications such as cardiac arrest and sudden death. We included separate sections on complications including thromboembolism and ventricular arrhythmias. Since its mechanism is currently a gray area, we included a separate section on basic science research studies that are warranted in the future to comprehend its underlying pathogenic mechanisms. CONCLUSIONS Taken together, this review builds upon the current literature of COVID-19-induced A-fib, including pathophysiology, clinical presentation, treatment and complications. Furthermore, it provides recommendations for future research moving forward that can open avenues for developing novel remedies that can prevent as well as hasten clinical recovery of atrial fibrillation in COVID-19 patients.
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Sokolova AA, Kudriavtseva AA, Kostokova NV, Zaikina MP, Gebekova ZA, Napalkov DA, Zolotukhin IA. Risk of Venous Thromboembolic Complications in Patients with Atrial Fibrillation: a Systematic Review and Meta-analysis. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2022. [DOI: 10.20996/1819-6446-2022-06-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aim: The aim of this meta-analysis and systematic review was to evaluate the possible connection between AF and VTE.Material and methods. Atrial fibrillation (AF) and atrial flutter (AFL) contribute to intra-atrial blood stasis which leads to thrombus formation with its embolization. There is some evidence that AF can be a risk factor for deep vein thrombosis (DVT) and pulmonary embolism (PE). The following databases were searched: PubMed (MEDLINE), EMBASE, Google Scholar, the Cochrane Central Register of Controlled Trials. The time frame for conducting a systematic literature search ranged from January 1, 1990 to November 1, 2021. The diagnosis of atrial fibrillation had to be confirmed by using ECG. The diagnosis of VTE could be made with Doppler imaging, ventilation/perfusion scan, CT angiography, venography, angiography or autopsy. Only the three studies with 102192 patients meeting the requirement were included in the meta-analysis.Results. The prevalence of DVT and PE were assessed using incidence rate ratios (IRR) method of the inverse variance random effects model and its 95% confidence interval (CI). The significant association between atrial fibrillation and pulmonary embolism was found (IRR, 4.18 95% Cl 1.958.98). Also there is obvious association between DVT and AF (IRR, 2.97 95% Cl 2.18-4.03).Conclusion. It can be concluded that the increased risk of developing VTE is associatedwith concomitant AF.
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Affiliation(s)
- A. A. Sokolova
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - A. A. Kudriavtseva
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - N. V. Kostokova
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - M. P. Zaikina
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - Z. A. Gebekova
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - D. A. Napalkov
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
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Abstract
The care pathway for patients with atrial fibrillation (AF) is variable and this variability is explored in a patient pathway review. This review describes events that may take place for a patient with AF considering the "ideal" and the "real-world" pathway and attempts to rationalize them by considering the patient, clinician, health service, and societal perspective. In the "ideal" pathway, AF in a patient is either identify before or after stroke. The "real-world" pathway introduces the concepts that symptoms may influence patient decision-making to seek help, AF may be identified incidentally, and healthcare professionals may fail to identify AF. The management of AF includes no treatment or treatment such as stroke prevention, rate or rhythm control, and comorbidity management. The overall outcomes for patient depend on the presence of symptoms and response to therapies. The two major priorities for patients are symptomatic relief and avoidance of stroke. While most clinicians will find that initial AF management is not challenging but there may be incidental opportunities for earlier identification. From the healthcare service perspective, noncardiologists and cardiologists care for patients with AF, which results in much heterogeneity management. From the societal perspective, the burden of AF is significant resulting in substantial cost from hospitalizations and treatments. People with AF can take on different paths, which depend on factors related to the patient's decision-making, clinical decision-making, and patient's response to the treatment. A streamlined approach to a holistic and integrated care pathway approach to AF management is needed.
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Affiliation(s)
- Chun Shing Kwok
- From the Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK; and the
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool & Liverpool Heart and Chest Hospital, Liverpool, UK
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6
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Noubiap JJ, Nyaga UF, Middeldorp ME, Fitzgerald JL, Ariyaratnam JP, Thomas G, Sanders P. Frequency and prognostic significance of atrial fibrillation in acute pulmonary embolism: A pooled analysis. Respir Med 2022; 199:106862. [DOI: 10.1016/j.rmed.2022.106862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/08/2022] [Accepted: 04/25/2022] [Indexed: 10/18/2022]
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Hoskin S, Brieger D, Chow V, Kritharides L, Ng ACC. Trends in Acute Pulmonary Embolism Admission Rates and Mortality Outcomes in Australia, 2002-2003 to 2017-2018: A Retrospective Cohort Study. Thromb Haemost 2021; 121:1237-1245. [PMID: 33641139 DOI: 10.1055/s-0041-1725932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Contemporary Australian epidemiological data on acute pulmonary embolism (PE) are lacking. OBJECTIVES To determine the admission rates of acute PE in Australia, and to assess the temporal trends in short- and medium-term mortality following acute PE. METHODS Retrospective population-linkage study of all New South Wales residents admitted with a primary diagnosis of PE between January 1, 2002 and December 31, 2018 using data from the Centre for Health Record Linkage databases. Main outcome measures included temporal trends in total PE admissions and all-cause mortality at prespecified time points up to 1 year, stratified by gender. RESULTS There were 61,607 total PE admissions between 2002 and 2018 (mean ± standard deviation: 3,624 ± 429 admissions per annum; 50.42 ± 3.70 admissions per 100,000 persons per annum). The mean admission rate per annum was higher for females than for males (54.85 ± 3.65 vs. 44.91 ± 4.34 admissions per 100,000 persons per annum, respectively) and remained relatively stable for both genders throughout the study period. The main study cohort, limited to index PE admission only, comprised 46,382 persons (mean age: 64.6 ± 17.3 years; 44.4% males). The cumulative in-hospital, 30-day, 3-month, and 1-year mortality rates were 3.7, 5.6, 9.6, and 16.8%, respectively. When compared with 2002 as the reference year, there was a significant reduction in in-hospital (odds ratio [OR] = 0.34; 95% confidence interval [CI] = 0.25-0.46), 30-day (OR = 0.58, 95% CI = 0.46-0.73), and 1-year (hazard ratio = 0.74, 95% CI = 0.66-0.84) (all p < 0.001) mortality risk by 2017 after adjusting for age, gender, and relevant confounders. The survival improvements were seen in both genders and were greater for females than for males. CONCLUSION Mortality following PE has improved with reductions observed in both short- and medium-term follow-ups between 2002 and 2018 with greater reductions in females despite their higher admission rates over time.
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Affiliation(s)
- Scott Hoskin
- Department of Cardiology, Concord Hospital, The University of Sydney, Concord, NSW, Australia
| | - David Brieger
- Department of Cardiology, Concord Hospital, The University of Sydney, Concord, NSW, Australia
| | - Vincent Chow
- Department of Cardiology, Concord Hospital, The University of Sydney, Concord, NSW, Australia
| | - Leonard Kritharides
- Department of Cardiology, Concord Hospital, The University of Sydney, Concord, NSW, Australia
| | - Austin Chin Chwan Ng
- Department of Cardiology, Concord Hospital, The University of Sydney, Concord, NSW, Australia
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8
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Calder LA, Perry J, Yan JW, De Gorter R, Sivilotti MLA, Eagles D, Myslik F, Borgundvaag B, Émond M, McRae AD, Taljaard M, Thiruganasambandamoorthy V, Cheng W, Forster AJ, Stiell IG. Adverse Events Among Emergency Department Patients With Cardiovascular Conditions: A Multicenter Study. Ann Emerg Med 2021; 77:561-574. [PMID: 33612283 DOI: 10.1016/j.annemergmed.2020.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Indexed: 11/16/2022]
Abstract
STUDY OBJECTIVE We aim to determine incidence and type of adverse events (adverse outcomes related to emergency care) among emergency department (ED) patients discharged with recent-onset atrial fibrillation, acute heart failure, and syncope. METHODS This 5-year prospective cohort study included high-acuity adult patients discharged with the 3 sentinel diagnoses from 6 tertiary care Canadian EDs. We screened all ED visits for eligibility and performed telephone interviews 14 days postdischarge to identify flagged outcomes: death, hospital admission, return ED visit, health care provider visit, and new or worsening symptoms. We created case summaries describing index ED visit and flagged outcomes, and trained emergency physicians reviewed case summaries to identify adverse events. We reported adverse event incidence and rates with 95% confidence intervals and contributing factor themes. RESULTS Among 4,741 subjects (mean age 70.2 years; 51.2% men), we observed 170 adverse events (3.6 per 100 patients; 95% confidence interval 3.1 to 4.2). Patients discharged with acute heart failure were most likely to experience adverse events (5.3%), followed by those with atrial fibrillation (2.0%) and syncope (0.8%). We noted variation in absolute adverse event rates across sites from 0.7 to 6.0 per 100 patients. The most common adverse event types were management issues, diagnostic issues, and unsafe disposition decisions. Frequent contributing factor themes included failure to recognize underlying causes and inappropriate management of dual diagnoses. CONCLUSION Among adverse events after ED discharge for patients with these 3 sentinel cardiovascular diagnoses, we identified quality improvement opportunities such as strengthening dual diagnosis detection and evidence-based clinical practice guideline adherence.
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Affiliation(s)
- Lisa A Calder
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
| | - Jeffrey Perry
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Justin W Yan
- Division of Emergency Medicine, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, Lawson Health Research Institute, London, Ontario, Canada
| | - Ria De Gorter
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Marco L A Sivilotti
- Departments of Emergency Medicine and Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| | - Debra Eagles
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Frank Myslik
- Division of Emergency Medicine, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, Lawson Health Research Institute, London, Ontario, Canada
| | - Bjug Borgundvaag
- Schwartz/Reisman Emergency Medicine Institute, Sinai Health System, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Marcel Émond
- Département de médecine Familiale et d'Urgence, Université Laval, Québec City, Quebec, Canada
| | - Andrew D McRae
- Departments of Emergency Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Venkatesh Thiruganasambandamoorthy
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Wei Cheng
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Alan J Forster
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Ian G Stiell
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
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Tang RB, Jing YY, Xu ZY, Dong JZ, Du X, Wu JH, Yu RH, Long DY, Ning M, Sang CH, Jiang CX, Bai R, Liu N, Wen SN, Li SN, Chen X, Huang ST, Cui YK, Ma CS. New-Onset Atrial Fibrillation and Adverse In-Hospital Outcome in Patients with Acute Pulmonary Embolism. Semin Thromb Hemost 2020; 46:887-894. [PMID: 33368110 DOI: 10.1055/s-0040-1718397] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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.
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Affiliation(s)
- Ri-Bo Tang
- 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
- Department of Cardiology, Yantai Yuhuangding Hospital, Qingdao University, Shandong Province, People's Republic of China
| | - Zhi-Yuan Xu
- 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.,Department of Cardiology, Yantai Yuhuangding Hospital, Qingdao University, Shandong Province, People's Republic of China
| | - Jian-Zeng Dong
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
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10
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Anfinogenova ND, Vasiltseva OY, Vrublevsky AV, Vorozhtsova IN, Popov SV, Smorgon AV, Mochula OV, Ussov WY. Right Atrial Thrombosis and Pulmonary Embolism: A Narrative Review. Semin Thromb Hemost 2020; 46:895-907. [PMID: 33368111 DOI: 10.1055/s-0040-1718399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Prompt diagnosis of pulmonary embolism (PE) remains challenging, which often results in a delayed or inappropriate treatment of this life-threatening condition. Mobile thrombus in the right cardiac chambers is a neglected cause of PE. It poses an immediate risk to life and is associated with an unfavorable outcome and high mortality. Thrombus residing in the right atrial appendage (RAA) is an underestimated cause of PE, especially in patients with atrial fibrillation. This article reviews achievements and challenges of detection and management of the right atrial thrombus with emphasis on RAA thrombus. The capabilities of transthoracic and transesophageal echocardiography and advantages of three-dimensional and two-dimensional echocardiography are reviewed. Strengths of cardiac magnetic resonance imaging (CMR), computed tomography, and cardiac ventriculography are summarized. We suggest that a targeted search for RAA thrombus is necessary in high-risk patients with PE and atrial fibrillation using transesophageal echocardiography and/or CMR when available independently on the duration of the disease. High-risk patients may also benefit from transthoracic echocardiography with right parasternal approach. The examination of high-risk patients should involve compression ultrasonography of lower extremity veins along with the above-mentioned technologies. Algorithms for RAA thrombus risk assessment and protocols aimed at identification of patients with RAA thrombosis, who will potentially benefit from treatment, are warranted. The development of treatment protocols specific for the diverse populations of patients with right cardiac thrombosis is important.
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Affiliation(s)
- Nina D Anfinogenova
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
| | - Oksana Y Vasiltseva
- Unit of Aorta and Coronary Artery Surgery, E. Meshalkin National Medical Research Center, Ministry of Health of Russian Federation, Novosibirsk, Russia
| | - Alexander V Vrublevsky
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
| | - Irina N Vorozhtsova
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
| | - Sergey V Popov
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
| | - Andrey V Smorgon
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
| | - Olga V Mochula
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
| | - Wladimir Y Ussov
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
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11
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Jiménez-García R, Albaladejo-Vicente R, Hernandez-Barrera V, Villanueva-Orbaiz R, Carabantes-Alarcon D, de-Miguel-Diez J, Zamorano-Leon JJ, Lopez-de-Andres A. Type 2 Diabetes Is a Risk Factor for Suffering and for in-Hospital Mortality with Pulmonary Embolism. A Population-Based Study in Spain (2016-2018). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228347. [PMID: 33187341 PMCID: PMC7698274 DOI: 10.3390/ijerph17228347] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 10/29/2020] [Accepted: 11/10/2020] [Indexed: 12/19/2022]
Abstract
(1) Background: The relationship between type 2 diabetes (T2DM) and pulmonary embolism (PE) has not been well stablished so far. We aim to analyze incidence, clinical conditions and in-hospital mortality (IHM) according to the presence of T2DM among patients hospitalized for suffering from PE. The factors associated with IHM were identified. (2) Methods: Patients aged ≥40 years hospitalized for PE from 2016 to 2018 included in the Spanish National Health System Hospital Discharge Database were analyzed. Dependent variables included incidence, IHM and length of hospital stay. Independent variables were age, sex, diagnosed comorbidities, thrombolytic therapy and inferior vena cava filter placement. Poisson and logistic regression models were constructed for multivariable analysis. (3) Results: Of the 47,190 hospitalizations for PE recorded, 16.52% had T2DM. Adjusted incidence of PE was higher among T2DM women (IRR 1.83; 95% CI: 1.58-1.96) and men (IRR 1.22; 95% CI: 1.18-1.27) than among non-diabetic subjects. Crude IHM in T2DM patients with PE was similar in both sexes but higher than in non-diabetic patients. Among T2DM patients with PE, risk factors for IHM included older age, comorbidity, atrial fibrillation and massive PE. Obesity was associated with lower IHM. Suffering T2DM was a risk of IHM (OR 1.15; 95% CI 1.05-1.26) after PE. (4) Conclusions: The incidence of PE is higher in T2DM men and women than in non-diabetic patients. T2DM was a risk factor for IHM after PE.
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Affiliation(s)
- Rodrigo Jiménez-García
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain; (R.J.-G.); (R.V.-O.); (D.C.-A.); (J.J.Z.-L.)
| | - Romana Albaladejo-Vicente
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain; (R.J.-G.); (R.V.-O.); (D.C.-A.); (J.J.Z.-L.)
- Correspondence:
| | - Valentin Hernandez-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, 28922 Madrid, Spain; (V.H.-B.); (A.L.-d.-A.)
| | - Rosa Villanueva-Orbaiz
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain; (R.J.-G.); (R.V.-O.); (D.C.-A.); (J.J.Z.-L.)
| | - David Carabantes-Alarcon
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain; (R.J.-G.); (R.V.-O.); (D.C.-A.); (J.J.Z.-L.)
| | - Javier de-Miguel-Diez
- Respiratory Department, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), 28009 Madrid, Spain;
| | - José Javier Zamorano-Leon
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain; (R.J.-G.); (R.V.-O.); (D.C.-A.); (J.J.Z.-L.)
| | - Ana Lopez-de-Andres
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, 28922 Madrid, Spain; (V.H.-B.); (A.L.-d.-A.)
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12
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Hald EM, Løchen ML, Mathiesen EB, Wilsgaard T, Njølstad I, Brækkan SK, Hansen JB. Atrial fibrillation, venous thromboembolism, ischemic stroke, and all-cause mortality: The Tromsø study. Res Pract Thromb Haemost 2020; 4:1004-1012. [PMID: 32864551 PMCID: PMC7443434 DOI: 10.1002/rth2.12351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 03/26/2020] [Accepted: 04/01/2020] [Indexed: 01/23/2023] Open
Abstract
Background Atrial fibrillation (AF) is associated with increased risk of ischemic stroke and all-cause mortality. Patients with AF are also at increased risk of venous thromboembolism (VTE), but information on how AF impacts VTE-related mortality is scarce. Objectives To investigate the impact of AF on all-cause mortality in subjects with and without a thromboembolic event (VTE or ischemic stroke). Methods We followed 29 833 participants from the Tromsø study (1994-2008) through 2013 and recorded all deaths during follow-up. Incident AF, VTE, and ischemic stroke were registered as time-dependent exposures. We calculated mortality rates (MRs) by exposure during follow-up and obtained hazard ratios (HRs) for death with 95% confidence intervals (CIs). Results A total of 2087 AF cases, 756 VTEs, and 1279 ischemic strokes were registered during a median follow-up of 18.7 years, and 4797 people (16.1%) died. The age-adjusted MR for participants without any event was 1.19 per 100 person-years (PY; 95% CI, 1.15-1.23). Compared to these participants, subjects with the joint AF + VTE exposure had a 3.7-fold increased risk of death (HR, 3.67; 95% CI, 2.77-4.66) in age- and sex-adjusted analyses, similar to the risk observed for VTE alone (HR, 3.76; 95% CI, 3.28-4.30). Participants with stroke had a 2.9-fold increased risk of death (HR, 2.85; 95% CI, 2.56-3.18), and the risk was further increased in participants with both AF and stroke (HR, 4.38; 95% CI, 3.85-4.98). Conclusions AF was significantly associated with increased risk of death in participants with incident stroke. In contrast, concomitant AF was not associated with excess mortality risk in VTE patients.
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Affiliation(s)
- Erin Mathiesen Hald
- K. G. Jebsen - Thrombosis Research and Expertise Center (TREC) Department of Clinical Medicine UiT The Arctic University of Norway Tromsø Norway.,Division of Internal Medicine University Hospital of North Norway Tromsø Norway
| | - Maja-Lisa Løchen
- Epidemiology of Chronic Diseases Research Group Department of Community Medicine UiT The Arctic University of Norway Tromsø Norway
| | - Ellisiv B Mathiesen
- K. G. Jebsen - Thrombosis Research and Expertise Center (TREC) Department of Clinical Medicine UiT The Arctic University of Norway Tromsø Norway.,Brain and Circulation Research Group Department of Clinical Medicine UiT The Arctic University of Norway Tromsø Norway
| | - Tom Wilsgaard
- Epidemiology of Chronic Diseases Research Group Department of Community Medicine UiT The Arctic University of Norway Tromsø Norway
| | - Inger Njølstad
- K. G. Jebsen - Thrombosis Research and Expertise Center (TREC) Department of Clinical Medicine UiT The Arctic University of Norway Tromsø Norway.,Epidemiology of Chronic Diseases Research Group Department of Community Medicine UiT The Arctic University of Norway Tromsø Norway
| | - Sigrid K Brækkan
- K. G. Jebsen - Thrombosis Research and Expertise Center (TREC) Department of Clinical Medicine UiT The Arctic University of Norway Tromsø Norway.,Division of Internal Medicine University Hospital of North Norway Tromsø Norway
| | - John-Bjarne Hansen
- K. G. Jebsen - Thrombosis Research and Expertise Center (TREC) Department of Clinical Medicine UiT The Arctic University of Norway Tromsø Norway.,Division of Internal Medicine University Hospital of North Norway Tromsø Norway
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13
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Gümüşdağ A, Burak C, Süleymanoğlu M, Yesin M, Tanık VO, Karabağ Y, Çağdaş M, Rencüzoğulları İ. The predictive value of RS time for short term mortality in patients with acute pulmonary embolism. J Electrocardiol 2020; 62:94-99. [PMID: 32835986 DOI: 10.1016/j.jelectrocard.2020.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/11/2020] [Accepted: 07/17/2020] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Many studies have examined the capability of electrocardiography (ECG) changes to predict the severity and prognosis of patients with acute pulmonary embolism (APE). RS time in ECG is potentially valuable in evaluating the prognosis of APE. In our study, we aimed to assess the predictive value of RS time, which is a novel electrocardiographic parameter of one-month mortality of APE. METHODS This retrospective study included 216 patients who were diagnosed with APE by pulmonary computed tomography angiography. RS time was measured from the ECG (inferolateral leads) at the time of hospital admission using a computer program (imagej.nih.gov/ij/). The patients were divided into two groups according to the median values of RS time: the group with RS time ≤ 60 msec (n:108) and the group with RS time > 60 msec (n:108). The groups were compared in terms of mortality. RESULTS In our study, the one-month mortality was 15.3% (33) in the patients hospitalized with APE. In the multivariate analysis, RS time prolongation (HR: 1.037; 95%CI: 1.005-1.065; p = .02) was independently correlated with mortality. The ROC curve analysis revealed that RS time > 64.8 msec predicted the one-month mortality in APE with a sensitivity of 68.6% and a specificity of 73.9% (AUC: 0.708; 95% CI: 0.643-0.768; p < .001). CONCLUSION As a novel ECG parameter, RS time could be measured for each patient with APE. Prolongation of RS time could be a useful index for predicting the one-month mortality of patients diagnosed with APE.
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Affiliation(s)
- Ayça Gümüşdağ
- Kafkas University, Faculty of Medicine, Department of Cardiology, Kars, Turkey.
| | - Cengiz Burak
- Kafkas University, Faculty of Medicine, Department of Cardiology, Kars, Turkey
| | | | - Mahmut Yesin
- Kafkas University, Faculty of Medicine, Department of Cardiology, Kars, Turkey
| | - Veysel Ozan Tanık
- Dışkapı Yıldırım Beyazıt Training and Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Yavuz Karabağ
- Kafkas University, Faculty of Medicine, Department of Cardiology, Kars, Turkey
| | - Metin Çağdaş
- Kafkas University, Faculty of Medicine, Department of Cardiology, Kars, Turkey
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14
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Kornej J, Börschel CS, Benjamin EJ, Schnabel RB. Epidemiology of Atrial Fibrillation in the 21st Century: Novel Methods and New Insights. Circ Res 2020; 127:4-20. [PMID: 32716709 DOI: 10.1161/circresaha.120.316340] [Citation(s) in RCA: 589] [Impact Index Per Article: 147.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Accompanying the aging of populations worldwide, and increased survival with chronic diseases, the incidence and prevalence of atrial fibrillation (AF) are rising, justifying the term global epidemic. This multifactorial arrhythmia is intertwined with common concomitant cardiovascular diseases, which share classical cardiovascular risk factors. Targeted prevention programs are largely missing. Prevention needs to start at an early age with primordial interventions at the population level. The public health dimension of AF motivates research in modifiable AF risk factors and improved precision in AF prediction and management. In this review, we summarize current knowledge in an attempt to untangle these multifaceted associations from an epidemiological perspective. We discuss disease trends, preventive opportunities offered by underlying risk factors and concomitant disorders, current developments in diagnosis and risk prediction, and prognostic implications of AF and its complications. Finally, we review current technological (eg, eHealth) and methodological (artificial intelligence) advances and their relevance for future prevention and disease management.
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Affiliation(s)
- Jelena Kornej
- From the National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts & Sections of Cardiovascular Medicine and Preventive Medicine, Boston Medical Center (J.K., E.J.B.), Boston University School of Medicine, MA
| | - Christin S Börschel
- Department of General and Interventional Cardiology, University Heart & Vascular Center Hamburg Eppendorf, Hamburg, Germany (C.B., R.B.S.)
- German Center for Cardiovascular Research (DZHK) partner site Hamburg/Kiel/Lübeck (C.B., R.B.S.)
| | - Emelia J Benjamin
- From the National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts & Sections of Cardiovascular Medicine and Preventive Medicine, Boston Medical Center (J.K., E.J.B.), Boston University School of Medicine, MA
- Department of Epidemiology (E.J.B.), Boston University School of Medicine, MA
| | - Renate B Schnabel
- Department of General and Interventional Cardiology, University Heart & Vascular Center Hamburg Eppendorf, Hamburg, Germany (C.B., R.B.S.)
- German Center for Cardiovascular Research (DZHK) partner site Hamburg/Kiel/Lübeck (C.B., R.B.S.)
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15
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Wang EY, Hulme OL, Khurshid S, Weng LC, Choi SH, Walkey AJ, Ashburner JM, McManus DD, Singer DE, Atlas SJ, Benjamin EJ, Ellinor PT, Trinquart L, Lubitz SA. Initial Precipitants and Recurrence of Atrial Fibrillation. Circ Arrhythm Electrophysiol 2020; 13:e007716. [PMID: 32078361 DOI: 10.1161/circep.119.007716] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) may occur after an acute precipitant and subsequently resolve. Management guidelines for AF in these settings are unclear as the risk of recurrent AF and related morbidity is poorly understood. We examined the relations between acute precipitants of AF and long-term recurrence of AF in a clinical setting. METHODS From a multi-institutional longitudinal electronic medical record database, we identified patients with newly diagnosed AF between 2000 and 2014. We developed algorithms to identify acute AF precipitants (surgery, sepsis, pneumonia, pneumothorax, respiratory failure, myocardial infarction, thyrotoxicosis, alcohol, pericarditis, pulmonary embolism, and myocarditis). We assessed risks of AF recurrence in individuals with and without a precipitant and the relations between AF recurrence and heart failure, stroke, and mortality. RESULTS Among 10 723 patients with newly diagnosed AF (67.9±9.9 years, 41% women), 19% had an acute AF precipitant, the most common of which were cardiac surgery (22%), pneumonia (20%), and noncardiothoracic surgery (15%). The cumulative incidence of AF recurrence at 5 years was 41% among individuals with a precipitant compared with 52% in those without a precipitant (adjusted hazard ratio [HR], 0.75 [95% CI, 0.69-0.81]; P<0.001). The lowest risk of recurrence among those with precipitants occurred with postoperative AF (5-year incidence 32% in cardiac surgery and 39% in noncardiothoracic surgery). Regardless of the presence of an initial precipitant, recurrent AF was associated with increased adjusted risks of heart failure (hazard ratio, 2.74 [95% CI, 2.39-3.15]; P<0.001), stroke (hazard ratio, 1.57 [95% CI, 1.30-1.90]; P<0.001), and mortality (hazard ratio, 2.96 [95% CI, 2.70-3.24]; P<0.001). CONCLUSIONS AF after an acute precipitant frequently recurs, although the risk of recurrence is lower than among individuals without an acute precipitant. Recurrence is associated with substantial long-term morbidity and mortality. Future studies should address surveillance and management after newly diagnosed AF in the setting of an acute precipitant.
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Affiliation(s)
- Elizabeth Y Wang
- Cardiovascular Research Center (E.Y.W., O.L.H., S.K., L.-C.W., P.T.E.), Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston.,Department of Medicine, Columbia University Medical Center, New York, NY (E.Y.W.)
| | - Olivia L Hulme
- Cardiovascular Research Center (E.Y.W., O.L.H., S.K., L.-C.W., P.T.E.), Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston
| | - Shaan Khurshid
- Cardiovascular Research Center (E.Y.W., O.L.H., S.K., L.-C.W., P.T.E.), Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston.,Division of Cardiology (S.K., S.A.L.), Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston.,Cardiovascular Disease Initiative, The Broad Institute of Harvard and MIT, Cambridge, MA (S.K., L.-C.W., S.H.C., P.T.E., S.A.L.)
| | - Lu-Chen Weng
- Cardiovascular Research Center (E.Y.W., O.L.H., S.K., L.-C.W., P.T.E.), Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston.,Cardiovascular Disease Initiative, The Broad Institute of Harvard and MIT, Cambridge, MA (S.K., L.-C.W., S.H.C., P.T.E., S.A.L.)
| | - Seung Hoan Choi
- Cardiovascular Disease Initiative, The Broad Institute of Harvard and MIT, Cambridge, MA (S.K., L.-C.W., S.H.C., P.T.E., S.A.L.)
| | - Allan J Walkey
- Boston University School of Medicine (A.J.W.), Harvard Medical School, MA
| | - Jeffrey M Ashburner
- Division of General Internal Medicine (J.M.A., D.E.S., S.J.A.), Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston.,Department of Medicine (J.M.A., D.E.S., S.J.A.), Harvard Medical School, MA
| | - David D McManus
- Department of Medicine, University of Massachusetts Medical School, Worcester (D.D.M.)
| | - Daniel E Singer
- Division of General Internal Medicine (J.M.A., D.E.S., S.J.A.), Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston.,Department of Medicine (J.M.A., D.E.S., S.J.A.), Harvard Medical School, MA
| | - Steven J Atlas
- Division of General Internal Medicine (J.M.A., D.E.S., S.J.A.), Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston.,Department of Medicine (J.M.A., D.E.S., S.J.A.), Harvard Medical School, MA
| | - Emelia J Benjamin
- Department of Medicine, Sections of Preventive Medicine and Cardiovascular Medicine (E.J.B.), Harvard Medical School, MA.,Boston University and National Heart, Lung and Blood Institute's Framingham Heart Study (E.J.B.), Boston University School of Public Health, MA.,Department of Epidemiology (E.J.B.), Boston University School of Public Health, MA
| | - Patrick T Ellinor
- Cardiovascular Research Center (E.Y.W., O.L.H., S.K., L.-C.W., P.T.E.), Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston.,Cardiovascular Disease Initiative, The Broad Institute of Harvard and MIT, Cambridge, MA (S.K., L.-C.W., S.H.C., P.T.E., S.A.L.)
| | - Ludovic Trinquart
- Department of Biostatistics (L.T.), Boston University School of Public Health, MA
| | - Steven A Lubitz
- Division of Cardiology (S.K., S.A.L.), Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston.,Cardiovascular Disease Initiative, The Broad Institute of Harvard and MIT, Cambridge, MA (S.K., L.-C.W., S.H.C., P.T.E., S.A.L.)
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16
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Yang Y, Liu B, Taylor J, Huang Z, Gupta S, Thumma S, Wu L, Wang S, Everett G. Prevalence and Clinical Impact of Atrial Fibrillation in Patients with Pulmonary Embolism. South Med J 2020; 113:93-97. [DOI: 10.14423/smj.0000000000001059] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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17
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Ebner M, Rogge NIJ, Parwani AS, Sentler C, Lerchbaumer MH, Pieske B, Konstantinides SV, Hasenfuß G, Wachter R, Lankeit M. Atrial fibrillation is frequent but does not affect risk stratification in pulmonary embolism. J Intern Med 2020; 287:100-113. [PMID: 31602725 DOI: 10.1111/joim.12985] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Although prior studies indicate a high prevalence of atrial fibrillation (AF) in patients with pulmonary embolism (PE), the exact prevalence and prognostic impact are unknown. METHODS We aimed to investigate the prevalence, risk factors and prognostic impact of AF on risk stratification, in-hospital adverse outcomes and mortality in 528 consecutive PE patients enrolled in a single-centre registry between 09/2008 and 09/2017. RESULTS Overall, 52 patients (9.8%) had known AF and 57 (10.8%) presented with AF on admission; of those, 34 (59.6%) were newly diagnosed with AF. Compared to patients with no AF, overt hyperthyroidism was associated with newly diagnosed AF (OR 7.89 [2.99-20.86]), whilst cardiovascular risk comorbidities were more frequently observed in patients with known AF. Patients with AF on admission had more comorbidities, presented more frequently with tachycardia and elevated cardiac biomarkers and were hence stratified to higher risk classes. However, AF on admission had no impact on in-hospital adverse outcome (8.3%) and in-hospital mortality (4.5%). In multivariate logistic regression analyses corrected for AF on admission, NT-proBNP and troponin elevation as well as higher risk classes in risk assessment models remained independent predictors of an in-hospital adverse outcome. CONCLUSION Atrial fibrillation is a frequent finding in PE, affecting more than 10% of patients. However, AF was not associated with a higher risk of in-hospital adverse outcomes and did not affect the prognostic performance of risk assessment strategies. Thus, our data support the use of risk stratification tools for patients with acute PE irrespective of the heart rhythm on admission.
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Affiliation(s)
- M Ebner
- Department of Nephrology and Medical Intensive Care, Charité - University Medicine Berlin, Berlin, Germany.,Department of Internal Medicine and Cardiology, Charité - University Medicine Berlin, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site, Berlin, Germany
| | - N I J Rogge
- Clinic of Cardiology and Pneumology, Heart Center, University Medical Center, Goettingen, Germany
| | - A S Parwani
- Department of Internal Medicine and Cardiology, Charité - University Medicine Berlin, Berlin, Germany
| | - C Sentler
- Clinic of Cardiology and Pneumology, Heart Center, University Medical Center, Goettingen, Germany
| | - M H Lerchbaumer
- Department of Radiology, Charité - University Medicine Berlin, Berlin, Germany
| | - B Pieske
- Department of Internal Medicine and Cardiology, Charité - University Medicine Berlin, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - S V Konstantinides
- Center for Thrombosis and Hemostasis, University Medical Center, Mainz, Germany.,Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece
| | - G Hasenfuß
- Clinic of Cardiology and Pneumology, Heart Center, University Medical Center, Goettingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site, Goettingen, Germany
| | - R Wachter
- Clinic of Cardiology and Pneumology, Heart Center, University Medical Center, Goettingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site, Goettingen, Germany.,Clinic and Policlinic for Cardiology, University Hospital Leipzig, Leipzig, Germany
| | - M Lankeit
- Department of Internal Medicine and Cardiology, Charité - University Medicine Berlin, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site, Berlin, Germany.,Clinic of Cardiology and Pneumology, Heart Center, University Medical Center, Goettingen, Germany.,Center for Thrombosis and Hemostasis, University Medical Center, Mainz, Germany
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18
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Atrial Fibrillation in Patients with Acute Pulmonary Embolism: Clinical Significance and Impact on Prognosis. BIOMED RESEARCH INTERNATIONAL 2019; 2019:7846291. [PMID: 31531368 PMCID: PMC6720355 DOI: 10.1155/2019/7846291] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 07/30/2019] [Indexed: 11/22/2022]
Abstract
Pulmonary embolism (PE) is one of the most common causes of cardiovascular death. The most often PE etiology is a deep vein thrombosis (DVT) of the lower extremities, but embolic material can arise in pelvic or upper extremity veins as well as in right heart chambers. There is growing number of evidences of atrial fibrillation (AF) involvement in PE. The presence of AF in patients with PE may be both the cause and the consequence of PE. The PE association with AF should be considered in patients without confirmed DVT and with history of AF, which itself is associated with prothrombotic state. The valuable diagnostic method is echocardiography that may bring the insight into source of embolic material. Another possible AF and PE association is the AF as a consequence of an abrupt increase in pulmonary vascular resistance due to the occlusion of the pulmonary vessels. Large-scale population-based studies have provided a considerable body of evidence on the involvement of PE in the onset of subsequent AF. Another important issue is the influence of AF on prognosis in patients with PE. Most investigators demonstrated a negative impact of AF on mortality. The main problem to resolve is whether AF is an independent mortality risk factor or whether it occurs as a result of comorbidities or the severity of a PE episode. Although the pathophysiological basis of this bidirectional relationship exists, many questions are still unresolved and require further studies, including the significance of paroxysmal AF accompanying an acute PE episode, the usefulness of PE risk scales in patients with concomitant AF, and the effect of anticoagulant treatment on PE and AF occurrence. Regardless of the type of AF, clinicians should be alert to the possibility of PE in patients with previous history of AF or presenting with new-onset AF.
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Nguyen Q, Rivera-Lebron BN. Venous Thromboembolism in Special Populations: Preexisting Cardiopulmonary Disease, Cirrhosis, End-Stage Renal Disease, and Asplenia. Clin Chest Med 2019; 39:515-524. [PMID: 30122176 DOI: 10.1016/j.ccm.2018.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Venous thromboembolism (VTE) is a common cause of morbidity and mortality. Presence of preexisting conditions, such as cardiopulmonary diseases, cirrhosis, renal dysfunction, and asplenia, commonly occurs in VTE patients. Moreover, these conditions often are risk factors for developing VTE. These preexisting conditions make VTE diagnosis and treatment challenging and worsen outcomes. Current guidelines do not include detailed features in the diagnosis and management of patients with preexisting conditions. This review discusses presence of VTE in patients with preexisting cardiopulmonary diseases, cirrhosis, renal dysfunction, and asplenia.
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Affiliation(s)
- Quyen Nguyen
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh, UPMC Montefiore, 3459 Fifth Avenue, Pittsburgh, PA 15213, USA
| | - Belinda N Rivera-Lebron
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh, UPMC Montefiore, 3459 Fifth Avenue, Pittsburgh, PA 15213, USA.
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20
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Ouatu A, Floria M, Radu S, Tănase DM. Glomerular Filtration Rate as a Prognostic Marker in Acute Pulmonary Embolism. Med Princ Pract 2019; 28:497. [PMID: 30991385 PMCID: PMC6771063 DOI: 10.1159/000500405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 04/16/2019] [Indexed: 11/19/2022] Open
Affiliation(s)
- Anca Ouatu
- Sf. Spiridon Emergency Hospital, Iaşi, Romania
- Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
| | - Mariana Floria
- Sf. Spiridon Emergency Hospital, Iaşi, Romania,
- Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania,
| | - Smaranda Radu
- Cardiovascular Disease Institute, Iaşi, Romania
- Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
| | - Daniela Maria Tănase
- Sf. Spiridon Emergency Hospital, Iaşi, Romania
- Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
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21
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Hald EM, Rinde LB, Løchen ML, Mathiesen EB, Wilsgaard T, Njølstad I, Brækkan SK, Hansen JB. Atrial Fibrillation and Cause-Specific Risks of Pulmonary Embolism and Ischemic Stroke. J Am Heart Assoc 2018; 7:JAHA.117.006502. [PMID: 29378729 PMCID: PMC5850231 DOI: 10.1161/jaha.117.006502] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Background Atrial fibrillation (AF) is a well‐established risk factor for ischemic stroke (IS). Emerging evidence also indicates an association between AF and pulmonary embolism (PE). Because IS may potentially mediate the observed risk of PE in AF, we aimed to assess the impact of AF on the cause‐specific risks of PE and IS in a large cohort recruited from the general population. Methods and Results We observed 29 842 participants from 3 surveys of the Tromsø study (inclusion in 1994–1995, 2001–2002, and 2007–2008) to the end of 2012. Incident events of AF, IS, and PE during follow‐up were recorded, and information on potential confounders was obtained at baseline. Cox regression models, with AF as a time‐dependent variable, were used to calculate cause‐specific hazard ratios (HRs) with 95% confidence intervals (CIs) for PE and IS. There were 2067 participants diagnosed as having AF, 296 with PE and 1164 with IS, during a median of 17.6 years of follow‐up. The risks of PE (HR, 10.88; 95% CI, 6.23–18.89) and IS (HR, 6.16; 95% CI, 4.47–8.48) were substantially increased during the first 6 months after AF diagnosis, with crude incidence rates of 18.5 per 1000 person‐years for PE and 52.8 per 1000 person‐years for IS. The risk estimates remained elevated for both PE (HR, 1.72; 95% CI, 1.10–2.71) and IS (HR, 2.45; 95% CI, 2.05–2.92) throughout the study period. Conclusions AF was associated with increased cause‐specific risks of both PE and IS. Our findings infer that the risk of PE in AF is not explained by intermediate IS.
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Affiliation(s)
- Erin M Hald
- Department of Clinical Medicine, K. G. Jebsen Thrombosis Research and Expertise Center, UiT The Arctic University of Norway, Tromsø, Norway .,Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Ludvig B Rinde
- Department of Clinical Medicine, K. G. Jebsen Thrombosis Research and Expertise Center, UiT The Arctic University of Norway, Tromsø, Norway
| | - Maja-Lisa Løchen
- Epidemiology of Chronic Diseases Research Group, Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Ellisiv B Mathiesen
- Department of Clinical Medicine, K. G. Jebsen Thrombosis Research and Expertise Center, UiT The Arctic University of Norway, Tromsø, Norway.,Brain and Circulation Research Group, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Tom Wilsgaard
- Epidemiology of Chronic Diseases Research Group, Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Inger Njølstad
- Department of Clinical Medicine, K. G. Jebsen Thrombosis Research and Expertise Center, UiT The Arctic University of Norway, Tromsø, Norway.,Epidemiology of Chronic Diseases Research Group, Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Sigrid K Brækkan
- Department of Clinical Medicine, K. G. Jebsen Thrombosis Research and Expertise Center, UiT The Arctic University of Norway, Tromsø, Norway.,Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - John-Bjarne Hansen
- Department of Clinical Medicine, K. G. Jebsen Thrombosis Research and Expertise Center, UiT The Arctic University of Norway, Tromsø, Norway.,Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
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22
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Different manifestations of pulmonary embolism in younger compared to older patients: Clinical presentation, prediction rules and long-term outcomes. Adv Med Sci 2017; 62:254-258. [PMID: 28501724 DOI: 10.1016/j.advms.2017.01.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 12/02/2016] [Accepted: 01/10/2017] [Indexed: 11/21/2022]
Abstract
PURPOSE Data concerning specific manifestations of pulmonary embolism (PE) among younger patients are scarce. We aimed to evaluate differences in clinical presentation, PE prediction rules, thrombolytic treatment use and PE outcomes in younger (<50 years of age) compared to older patients. MATERIAL/METHODS We studied 238 consecutive patients with proven PE who were retrospectively categorized into three PE probability subgroups according to the revised Geneva score (RGS) and Wells score (WS). Duration of follow-up was up to 115 months. RESULTS Younger patients accounted for 19.7% of the study cohort. Obesity and smoking were significantly more common, while comorbidities were less common (P<0.05) in the younger patients. According to RGS and WS, younger patients were more often categorized into the low PE probability subgroup and rarely into the high probability subgroup (P<0.05). We found no differences in clinical signs, symptoms, and treatment between the two groups. In-hospital (2% vs. 13%) and long-term (12% vs. 36%) mortality rates were significantly lower in younger patients (P=0.003). CONCLUSIONS In younger PE patients, despite differences in predisposing factors and PE probability grading as assessed by RGS and WS, clinical features at admission and treatment were similar compared to the older group. Our findings confirmed lower mortality among younger compared to older patients.
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Qaddoura A, Digby GC, Kabali C, Kukla P, Zhan ZQ, Baranchuk AM. The value of electrocardiography in prognosticating clinical deterioration and mortality in acute pulmonary embolism: A systematic review and meta-analysis. Clin Cardiol 2017. [PMID: 28628222 DOI: 10.1002/clc.22742] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The role of electrocardiography (ECG) in prognosticating pulmonary embolism (PE) is increasingly recognized. ECG is quickly interpretable, noninvasive, inexpensive, and available in remote areas. We hypothesized that ECG can provide useful information about PE prognostication. We searched MEDLINE, EMBASE, Google Scholar, Web of Science, abstracts, conference proceedings, and reference lists through February 2017. Eligible studies used ECG to prognosticate for the main outcomes of death and clinical deterioration or escalation of therapy. Two authors independently selected studies; disagreement was resolved by consensus. Ad hoc piloted forms were used to extract data and assess risk of bias. We used a random-effects model to pool relevant data in meta-analysis with odds ratios (ORs) and 95% confidence intervals (CIs); all other data were synthesized qualitatively. Statistical heterogeneity was assessed using the I 2 value. We included 39 studies (9198 patients) in the systematic review. There was agreement in study selection (κ: 0.91, 95% CI: 0.86-0.96). Most studies were retrospective; some did not appropriately control for confounders. ECG signs that were good predictors of a negative outcome included S1Q3T3 (OR: 3.38, 95% CI: 2.46-4.66, P < 0.001), complete right bundle branch block (OR: 3.90, 95% CI: 2.46-6.20, P < 0.001), T-wave inversion (OR: 1.62, 95% CI: 1.19-2.21, P = 0.002), right axis deviation (OR: 3.24, 95% CI: 1.86-5.64, P < 0.001), and atrial fibrillation (OR: 1.96, 95% CI: 1.45-2.67, P < 0.001) for in-hospital mortality. Several ischemic patterns also were significantly predictive. Our conclusion is that ECG is potentially valuable in prognostication of acute PE.
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Affiliation(s)
- Amro Qaddoura
- Department of Medicine, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Geneviève C Digby
- Department of Medicine, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Conrad Kabali
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Piotr Kukla
- Department of Cardiology and Internal Medicine, Specialistic Hospital, Gorlice, Poland
| | - Zhong-Qun Zhan
- Department of Cardiology, Taihe Hospital, Hubei University of Medicine, Shiyan City, China
| | - Adrian M Baranchuk
- Department of Medicine, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
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24
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Paroxysmal Atrial Fibrillation in the Course of Acute Pulmonary Embolism: Clinical Significance and Impact on Prognosis. BIOMED RESEARCH INTERNATIONAL 2017; 2017:5049802. [PMID: 28280732 PMCID: PMC5322430 DOI: 10.1155/2017/5049802] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 01/16/2017] [Indexed: 11/17/2022]
Abstract
The relationship and clinical implications of atrial fibrillation (AF) in acute pulmonary embolism (PE) are poorly investigated. We aimed to analyze clinical characteristics and prognosis in PE patients with paroxysmal AF episode. Methods. From the 391 patients with PE 31 subjects with paroxysmal AF were selected. This group was compared with patients with PE and sinus rhythm (SR) and 32 patients with PE and permanent AF. Results. Paroxysmal AF patients were the oldest. Concomitant DVT varies between groups: paroxysmal AF 32.3%, SR 49.5%, and permanent AF 28.1% (p = 0.02). The stroke history frequency was 4.6% SR, 12.9% paroxysmal AF, and 21.9% permanent AF (p < 0.001). Paroxysmal AF comparing to permanent AF and SR individuals had higher estimated SPAP (56 versus 48 versus 47 mmHg, p = 0.01) and shorter ACT (58 versus 65 versus 70 ms, p = 0.04). Patients with AF were more often classified into high-risk group according to revised Geneva score and sPESI than SR patients. In-hospital mortality was lower in SR (5%) and paroxysmal AF (6.5%) compared to permanent AF group (25%) (p < 0.001). Conclusions. Patients with PE-associated paroxysmal AF constitute a separate population. More severe impairment of the parameters reflecting RV afterload may indicate relation between PE severity and paroxysmal AF episode. Paroxysmal AF has no impact on short-term mortality.
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Elias A, Mallett S, Daoud-Elias M, Poggi JN, Clarke M. Prognostic models in acute pulmonary embolism: a systematic review and meta-analysis. BMJ Open 2016; 6:e010324. [PMID: 27130162 PMCID: PMC4854007 DOI: 10.1136/bmjopen-2015-010324] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To review the evidence for existing prognostic models in acute pulmonary embolism (PE) and determine how valid and useful they are for predicting patient outcomes. DESIGN Systematic review and meta-analysis. DATA SOURCES OVID MEDLINE and EMBASE, and The Cochrane Library from inception to July 2014, and sources of grey literature. ELIGIBILITY CRITERIA Studies aiming at constructing, validating, updating or studying the impact of prognostic models to predict all-cause death, PE-related death or venous thromboembolic events up to a 3-month follow-up in patients with an acute symptomatic PE. DATA EXTRACTION Study characteristics and study quality using prognostic criteria. Studies were selected and data extracted by 2 reviewers. DATA ANALYSIS Summary estimates (95% CI) for proportion of risk groups and event rates within risk groups, and accuracy. RESULTS We included 71 studies (44,298 patients). Among them, 17 were model construction studies specific to PE prognosis. The most validated models were the PE Severity Index (PESI) and its simplified version (sPESI). The overall 30-day mortality rate was 2.3% (1.7% to 2.9%) in the low-risk group and 11.4% (9.9% to 13.1%) in the high-risk group for PESI (9 studies), and 1.5% (0.9% to 2.5%) in the low-risk group and 10.7% (8.8% to12.9%) in the high-risk group for sPESI (11 studies). PESI has proved clinically useful in an impact study. Shifting the cut-off or using novel and updated models specifically developed for normotensive PE improves the ability for identifying patients at lower risk for early death or adverse outcome (0.5-1%) and those at higher risk (up to 20-29% of event rate). CONCLUSIONS We provide evidence-based information about the validity and utility of the existing prognostic models in acute PE that may be helpful for identifying patients at low risk. Novel models seem attractive for the high-risk normotensive PE but need to be externally validated then be assessed in impact studies.
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Affiliation(s)
- Antoine Elias
- Department of Vascular Medicine, Sainte Musse Hospital, Toulon La Seyne Hospital Centre, Toulon, France
- DPhil Programme in Evidence-Based Healthcare, University of Oxford, Oxford, UK
| | - Susan Mallett
- Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Marie Daoud-Elias
- Department of Vascular Medicine, Sainte Musse Hospital, Toulon La Seyne Hospital Centre, Toulon, France
| | - Jean-Noël Poggi
- Department of Vascular Medicine, Sainte Musse Hospital, Toulon La Seyne Hospital Centre, Toulon, France
| | - Mike Clarke
- Northern Ireland Network for Trials Methodology Research, Queen's University Belfast, Belfast, UK
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Ng ACC, Adikari D, Yuan D, Lau JK, Yong ASC, Chow V, Kritharides L. The Prevalence and Incidence of Atrial Fibrillation in Patients with Acute Pulmonary Embolism. PLoS One 2016; 11:e0150448. [PMID: 26930405 PMCID: PMC4773188 DOI: 10.1371/journal.pone.0150448] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 02/14/2016] [Indexed: 11/25/2022] Open
Abstract
Background Symptomatic pulmonary embolism (PE) is a major cause of cardiovascular death and morbidity. Estimated prevalence and incidence of atrial fibrillation (AF) in developed countries are between 388–661 per 100,000, and 90–123 per 100,000 person-years respectively. However, the prevalence and incidence of AF in patients presenting with an acute PE and its predictors are not clear. Methods Individual patient clinical details were retrieved from a database containing all confirmed acute PE presentations to a tertiary institution from 2001–2012. Prevalence and incidence of AF was tracked from a population registry by systematically searching for AF during any hospital admission (2000–2013) based on International Classification of Disease (ICD-10) code. Results Of the 1,142 patients included in this study, 935 (81.9%) had no AF during index PE admission whilst 207 patients had documented baseline AF (prevalence rate 18,126 per 100,000; age-adjusted 4,672 per 100,000). Of the 935 patients without AF, 126 developed AF post-PE (incidence rate 2,778 per 100,000 person-years; age-adjusted 984 per 100,000 person-years). Mean time from PE to subsequent AF was 3.4 ± 2.9 years. Total mortality (mean follow-up 5.0 ± 3.7 years) was 42% (n = 478): 35% (n = 283), 59% (n = 119) and 60% (n = 76) in the no AF, baseline AF and subsequent AF cohorts respectively. Independent predictors for subsequent AF after acute PE include age (hazard ratio [HR] 1.06, 95% confidence interval [CI] 1.04–1.08, p<0.001), history of congestive cardiac failure (HR 1.88, 95% CI 1.12–3.16, p = 0.02), diabetes (HR 1.72, 95% CI 1.07–2.77, p = 0.02), obstructive sleep apnea (HR 4.83, 1.48–15.8, p = 0.009) and day-1 serum sodium level during index PE admission (HR 0.94, 95% CI 0.90–0.98, p = 0.002). Conclusions Patients presenting with acute PE have a markedly increased age-adjusted prevalence and subsequent incidence of AF. Screening for AF may be of importance post-PE.
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Affiliation(s)
- Austin Chin Chwan Ng
- Cardiology Department, The University of Sydney, Concord, New South Wales, Australia
- * E-mail: ;
| | - Dona Adikari
- Cardiology Department, The University of Sydney, Concord, New South Wales, Australia
| | - David Yuan
- Cardiology Department, The University of Sydney, Concord, New South Wales, Australia
| | - Jerrett K. Lau
- Cardiology Department, The University of Sydney, Concord, New South Wales, Australia
| | - Andy Sze Chiang Yong
- Cardiology Department, The University of Sydney, Concord, New South Wales, Australia
| | - Vincent Chow
- Cardiology Department, The University of Sydney, Concord, New South Wales, Australia
| | - Leonard Kritharides
- Cardiology Department, The University of Sydney, Concord, New South Wales, Australia
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Enga KF, Rye-Holmboe I, Hald EM, Løchen ML, Mathiesen EB, Njølstad I, Wilsgaard T, Braekkan SK, Hansen JB. Atrial fibrillation and future risk of venous thromboembolism:the Tromsø study. J Thromb Haemost 2015; 13:10-6. [PMID: 25330989 DOI: 10.1111/jth.12762] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 10/09/2014] [Indexed: 11/30/2022]
Abstract
AIMS Whether atrial fibrillation is related to risk of venous thromboembolism (VTE) has not been extensively studied. Therefore, we investigated the association between atrial fibrillation and future risk of VTE in a population-based cohort. METHODS In total, 29,975 subjects were recruited from three surveys of the Tromsø study and followed from enrollment (1994-1995, 2001-2002 and 2007-2008) up to 2010. Incident events of atrial fibrillation and VTE during follow-up were recorded. Information on potential confounders was obtained at baseline. Cox-regression models with atrial fibrillation as time-dependent variable were used to calculate hazard ratios (HRs) for VTE with 95% confidence intervals (CIs). RESULTS During 16 years of median follow-up, 1604 subjects were diagnosed with atrial fibrillation and 614 with incident VTE. The risk of VTE was substantially increased during the first 6 months after diagnosis of atrial fibrillation (HR, 8.44; 95% CI, 5.61-12.69), and remained increased throughout the study period (HR, 1.43; 95% CI, 1.43-1.99) compared with those without atrial fibrillation. Atrial fibrillation displayed higher risk estimates for pulmonary embolism (HR, 11.84; 95% CI, 6.80-20.63) than for deep vein thrombosis (HR, 6.20; 95% CI, 3.37-11.39) during the first 6 months, and was still associated with pulmonary embolism (HR, 1.96; 95% CI, 1.24-3.10) but not with deep vein thrombosis (HR, 1.08; 95% CI, 0.66-1.75) more than 6 months after diagnosis. CONCLUSION Atrial fibrillation was associated with increased risk of VTE, and pulmonary embolism in particular. Our findings support the concept that isolated pulmonary embolism may originate from right atrial thrombi due to atrial fibrillation.
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Affiliation(s)
- K F Enga
- K.G. Jebsen Thrombosis Research and Expertise Center, Department of Clinical Medicine, University of Tromsø, Tromsø, Norway; Hematological Research Group, Department of Clinical Medicine, University of Tromsø, Tromsø, Norway
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Ouatu A, Tãnase DM, Floria M, Ionescu SD, Ambãruş V, Arsenescu-Georgescu C. Chronic kidney disease: Prognostic marker of nonfatal pulmonary thromboembolism. Anatol J Cardiol 2014; 15:938-43. [PMID: 25868039 PMCID: PMC5336947 DOI: 10.5152/akd.2014.5739] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objective: Renal dysfunction is associated with increased cardiovascular morbidity and mortality. The alteration in renal function as a marker of mortality in pulmonary thromboembolism (PTE) has not been studied extensively. Methods: Four hundred four consecutive patients diagnosed with non-high-risk PTE (without cardiogenic shock or blood pressure <90 mm Hg) were prospectively enrolled in the study between 2005-2010. Kidney function, based on glomerular filtration rate (GFR), calculated by the simplified modification in diet in renal disease (MDRD) equation (sMDRD); troponin I; B-type natriuretic peptide (BNP); and echocardiographic markers of right ventricular (RV) function were determined in survivors versus non-survivors after a 2-year follow-up. Results: GFR was significantly lower in non-survivors than in survivors: 51.85±19.08 mL/min/1.73 m2 and 71.65±23.21 mL/min/1.73 m2, respectively (p=0.000). The highest 2-year mortality rate (20%) was recorded in patients with moderate renal dysfunction associated with RV dysfunction. Using multivariate analysis, we found that GFR is an independent predictor of 2-year mortality (OR 0.973, 95% CI: 0.959-0.987, p=0.000), besides troponin I, dyslipidemia, acceleration time of pulmonary ejection, pericardial effusion, and BNP Conclusion: The association of renal dysfunction with right ventricular dysfunction in patients with non-fatal pulmonary thromboembolism resulted in high mortality. Renal dysfunction, assessed by glomerular filtration rate, may be used in the risk stratification of patients with non-high-risk pulmonary thromboembolism, besides troponin I, BNP and right ventricle echocardiographic dysfunction markers.
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Affiliation(s)
- Anca Ouatu
- Grigore T.Popa University of Medicine and Pharmacy; Iaşi-România; IIIrd Medical Clinic from Sf. Spiridon University Hospital; Iaşi-România.
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29
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Akgüllü Ç, Ömürlü İK, Eryılmaz U, Avcil M, Dağtekin E, Akdeniz M, Güngör H, Zencir C. Predictors of early death in patients with acute pulmonary embolism. Am J Emerg Med 2014; 33:214-21. [PMID: 25499176 DOI: 10.1016/j.ajem.2014.11.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 11/10/2014] [Accepted: 11/15/2014] [Indexed: 10/24/2022] Open
Abstract
AIM We aimed to determine the predictors of early death in the course of acute pulmonary embolism (APE). MATERIALS AND METHODS We included 206 patients who had been admitted to our hospital between January 2011 and April 2013 with the diagnosis of APE. We derived a new model including corrected QT interval dispersion (QTcd) and P wave dispersion (Pd), echocardiographic findings, laboratory markers, and blood cell count indices to predict early death in patients with APE. RESULTS Thirty patients (14.5%) died; 176 patients (85.5%) lived after diagnosis of APE. Logistic regression (LR) analysis found that troponin I (odds ratio [OR], 1.084 [95% confidence interval {CI}, 1.009-1.165]), creatinine (OR, 4.153 [95% CI, 1.375-12.541]), mean platelet volume (OR, 1.991 [95% CI, 1.230-3.223]), neutrophil to lymphocyte ratio (NLR) (OR, 1.079 [95% CI, 1.005-1.160]), QTcd (OR, 1.084 [95% CI, 1.043-1.127]), Pd (OR, 1.049 [95% CI, 1.004-1.096]) were associated with early death in APE. New LR model (area under the curve [AUC], 0.970) performed better than the simplified pulmonary embolism severity index (sPESI) score (AUC, 0.859) in predicting early death in APE (P=.021). The predictivity of the sPESI score significantly improved after its single combination with creatinine, QTcd, or troponin I. When the combined model was constructed together with these 6 independent variables and sPESI score, stepwise LR model automatically excluded Pd and NLR, and the AUC from the rest of the combined model was 0.976, which is significantly different from the AUC of sPESI (0.859) (P=.0031). CONCLUSIONS Creatinine, troponin I, and QTcd significantly improves sPESI score. A new model with troponin I, creatinine, mean platelet volume, NLR, QTcd, and Pd seems to have greater prognostic power than the sPESI scoring system.
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Affiliation(s)
- Çağdaş Akgüllü
- Department of Cardiology, Medical Faculty, Adnan Menderes University, Aydin 09100, Turkey.
| | - İmran Kurt Ömürlü
- Department of Biostatistics, Medical Faculty, Adnan Menderes University, Aydin 09100, Turkey
| | - Ufuk Eryılmaz
- Department of Cardiology, Medical Faculty, Adnan Menderes University, Aydin 09100, Turkey
| | - Mücahit Avcil
- Emergency Department, Medical Faculty, Adnan Menderes University, Aydin 09100, Turkey
| | - Evrin Dağtekin
- Department of Cardiology, Medical Faculty, Adnan Menderes University, Aydin 09100, Turkey
| | - Mehmet Akdeniz
- Department of Cardiology, Medical Faculty, Adnan Menderes University, Aydin 09100, Turkey
| | - Hasan Güngör
- Department of Cardiology, Medical Faculty, Adnan Menderes University, Aydin 09100, Turkey
| | - Cemil Zencir
- Department of Cardiology, Medical Faculty, Adnan Menderes University, Aydin 09100, Turkey
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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 2014; 113:185-92. [PMID: 25318828 DOI: 10.1160/th14-05-0405] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 08/15/2014] [Indexed: 01/10/2023]
Abstract
Whether atrial fibrillation (AF) is associated with an increased risk of venous thromboembolism (VTE) remains controversial. From Longitudinal Health Insurance Database 2000 (LHID2000), we identified 11,458 patients newly diagnosed with AF. The comparison group comprised 45,637 patients without AF. Both cohorts were followed up to measure the incidence of deep-vein thrombosis (DVT) and pulmonary embolism (PE). Univariable and multivariable competing-risks regression model and Kaplan-Meier analyses with the use of Aelon-Johansen estimator were used to measure the differences of cumulative incidences of DVT and PE, respectively. The overall incidence rates (per 1,000 person-years) of DVT and PE between the AF group and non-AF groups were 2.69 vs 1.12 (crude hazard ratio [HR]= 1.92; 95 % confidence interval [CI] = 1.54-2.39), 1.55 vs 0.46 (crude HR = 2.68; 95 % CI = 1.97-3.64), respectively. The baseline demographics indicated that the members of the AF group demonstrated a significantly older age and higher proportions of comorbidities than non-AF group. After adjusting for age, sex, and comorbidities, the risks of DVT and PE remained significantly elevated in the AF group compared with the non-AF group (adjusted HR = 1.74; 95 %CI = 1.36-2.24, adjusted HR = 2.18; 95 %CI = 1.51-3.15, respectively). The Kaplan-Meier curve with the use of Aelon-Johansen estimator indicated that the cumulative incidences of DVT and PE were both more significantly elevated in the AF group than in the non-AF group after a long-term follow-up period (p<0.01). In conclusion, the presence of AF is associated with increased risk of VTE after a long-term follow-up period.
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Affiliation(s)
| | | | | | | | | | - Chia-Hung Kao
- Prof. Chia-Hung Kao, MD, Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, No. 2, Yuh-Der Road, Taichung 404, Taiwan, Tel.: +886 4 22052121×7412, Fax: +886 4 22336174, E-mail:
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Hald EM, Enga KF, Løchen ML, Mathiesen EB, Njølstad I, Wilsgaard T, Braekkan SK, Hansen JB. Venous thromboembolism increases the risk of atrial fibrillation: the Tromso study. J Am Heart Assoc 2014; 3:e000483. [PMID: 24385452 PMCID: PMC3959677 DOI: 10.1161/jaha.113.000483] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pulmonary embolism (PE) may trigger atrial fibrillation through increased right atrial pressure and subsequent atrial strain, but the degree of evidence is low. In this study, we wanted to investigate the impact of incident venous thromboembolism (VTE) on future risk of atrial fibrillation in a prospective population-based study. METHODS AND RESULTS The study included 29 974 subjects recruited from the Tromsø study (1994-1995, 2001-2002, 2007-2008). Incident VTE and atrial fibrillation events were registered from date of enrolment to end of follow-up, December 31, 2010. Cox proportional hazard regression models using age as time-scale and VTE as a time-dependent variable were used to estimate crude and multivariable hazard ratios (HRs) for atrial fibrillation with 95% confidence intervals (CIs). During 16 years of follow up, 540 (1.8%) subjects had an incident VTE event, and 1662 (5.54%) were diagnosed with atrial fibrillation. Among those with VTE, 50 (9.3%) developed subsequent atrial fibrillation. Patients with VTE had 63% higher risk of atrial fibrillation compared to subjects without VTE (multivariable-adjusted HR: 1.63, 95% CI: 1.22 to 2.17). The risk of atrial fibrillation was particularly high during the first 6 months after the VTE event (HR 4.00, 95% CI: 2.21 to 7.25) and among those with PE (HR 1.78, 95% CI: 1.13 to 2.80). CONCLUSIONS We found that incident VTE was associated with future risk of atrial fibrillation. Our findings support the hypothesis that PE may lead to cardiac dysfunctions that, in turn, could trigger atrial fibrillation.
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Affiliation(s)
- Erin M Hald
- Hematological Research Group, Department of Clinical Medicine, University of Tromsø, Tromsø, Norway
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