Effects of Salvianolic Acid B/ginsenoside Rg1 Combination Against Chronic Pulmonary Embolism Induced by Polystyrene Microspheres

Pulmonary embolism (PE) is the most life-threatening complication of venous thromboembolism, but few effective treatments have been discovered to attenuate chronic PE currently. In this study, we investigated the protective effects of salvianolic acid B (SalB) and ginsenoside Rg1 (Rg1) combination (SalB/Rg1) on chronic PE and explored the potential mechanisms. The PE model was induced by 45 μm polystyrene microspheres and 20 mg/kg of SalB/Rg1 was administered to PE rats intraperitoneally. A histopathological analysis of the lungs and heart was performed through hematoxylin and eosin staining and immunohistochemical analysis. The pulmonary index and right ventricular cardiomyocyte cross-sectional area were evaluated. SalB/Rg1 markedly downregulated pulmonary index, attenuated pulmonary interstitial changes, suppressed neutrophil infiltration, prevented collagen deposition, and inhibited MMP-9 activities in the lung. We also found that SalB/Rg1 improved right ventricular hypertrophy accompanied by reducing the cardiomyocyte cross-sectional area. These data suggest that SalB/Rg1 played a protective role against microsphere-induced PE and holds a high potential for the treatment of PE in the future.

Retrospective cohort study of new-onset atrial fibrillation in acute pulmonary embolism on prognosis

OBJECTIVES

To investigate the characteristics of new-onset atrial fibrillation (AF) and its impact on prognosis in acute pulmonary embolism (aPE).

DESIGN

A retrospective cohort study SETTING: The study cohort included patients diagnosed with aPE who were admitted to the Renmin Hospital of Wuhan University from January 2017 to January 2019.

PARTICIPANTS

Patients were ≥18 years of age and hospitalised for aPE.

OUTCOME MEASURES

AF was diagnosed based on an ECG recording or a Holter monitor during hospitalisation. aPE was diagnosed by CT pulmonary angiography. The prescription was determined from the discharge medication list. All-cause mortality was observed after 6-month follow-up. The logistic regression model and Cox proportional hazards model were used to study the risk factor of the new-onset AF and the predictor of all-cause mortality, respectively.

RESULTS

A total of 590 patients with aPE were enrolled, 23 (3.9%) in the new-onset paroxysmal AF group, 31 (5.3%) in the new-onset persistent AF group and 536 (90.8%) in the sinus rhythm (SR) group. The incidence of the new-onset AF was 9.2% (54/590). A significant difference in age, heart rate, cardiac troponin I ultra, amino-terminal pro-brain natriuretic peptide, D-dimer, left atrial diameter, left ventricular ejection fraction, pulmonary infection, venous thromboembolism, congestive heart failure, chronic cor pulmonale and ischaemic heart disease was found among the three groups (p<0.05). Risk factors for the new-onset AF were massive PE, ischaemic heart disease and congestive heart failure. The survival rate of the paroxysmal and persistent AF group was significantly lower than that of the SR group within 6 months (60.9% and 51.6% vs 88.8%, p<0.001). New-onset persistent AF (OR 2.73; 95% CI 1.28 to 5.81; p=0.009) was an independent predictor affecting the 6-month survival in aPE patients.

CONCLUSIONS

Massive PE, ischaemic heart disease and congestive heart failure are high-risk factors which were related to new-onset AF in aPE. New-onset persistent AF was an independent predictor for 6-month all-cause mortality in PE patients.

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

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.