Impact of atrial fibrillation on the dynamics of echocardiographic parameters in patients with pulmonary embolism during acute phase and one-year follow-up
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Abstract
The aim – to evaluate the follow-up of patients (pts) who had acute pulmonary embolism (PE) with concomitant atrial fibrillation (AF) during one-year period.
Materials and methods. We prospectively analyzed 97 pts hospitalized for «Acute PE» who were treated at Kharkiv City Clinical Hospital No.8. during 01.01.2023 – 01.01.2024. PE was verified by multispiral computed tomography angiography (CTPA) of pulmonary arteries and/or by autopsy. Among the 97 pts, 26 had concomitant AF (group A), 71 didn’t (group B). Clinical, anamnestic, biochemical, instrumental parameters were measured.
Results. Pts with AF were older (71.0±6.1 vs 60.7±12.4, p<0.05) and had more comorbidities. After 12 months pts with AF had higher levels of NT-proBNP (1989±3947 vs 216±753, p<0.05), higher values of indexed right atrial volume (36.7±14.7 vs 24.6±9.4, p<0.05), left atrial diameter (45.4±8.7 vs 38.4±4.3, p<0.05); lower values of systolic longitudinal right ventricle (RV) free wall strain values especially the basal (16.6±6.0 vs 21.7±8.3, p<0.05) and apical (12.2±7.3 vs 16.0±6.4, p<0.05) ones. There were detected episodes of AF with spontaneous sinus rhythm restoration in 2 pts by Holter monitoring 3 and 6 months after acute PE. 14 pts died during one-year follow-up: 7 – during in-hospital period, 7 – after discharge, 3 of whom had AF.
Conclusions. During a one-year follow-up, AF was detected in 26.8 % of pts with acute PE. These pts were, on average, 10,3 years older and more frequently had arterial hypertension, type 2 diabetes mellitus, heart failure and obesity. The presence of AF in pts with PE significantly affects cardiac structure and function recovery: larger right and left atria sizes, higher right atrial volume index, slightly decreased left ventricular ejection fraction and longitudinal RV free wall strain values; higher NT-proBNP levels — all of which are associated with a more severe clinical outcome.
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Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola VP, Huisman MV, Humbert M, Jennings CS, Jiménez D, Kucher N, Lang IM, Lankeit M, Lorusso R, Mazzolai L, Meneveau N, Ní Áinle F, Prandoni P, Pruszczyk P, Righini M, Torbicki A, Van Belle E, Zamorano JL; ESC Scientific Document Group. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J. 2020 Jan 21;41(4):543-603. https://doi.org/10.1093/eurheartj/ehz405
Yusuf MH, Anita A, Bolaji OA, Abdulkarim FM, Onyejesi CD, Yusuf M, Ekin U, Hazari AS, Ismail M. Impact of atrial fibrillation on pulmonary embolism hospitalization: Nationwide analysis. Am Heart J Plus. 2024 Sep 24;46:100465. https://doi.org/10.1016/j.ahjo.2024.100465
Noubiap JJ, Nyaga UF, Middeldorp ME, Fitzgerald JL, Ariyaratnam JP, Gijo Thomas, Sanders P. Frequency and prognostic significance of atrial fibrillation in acute pulmonary embolism: A pooled analysis, Respiratory Medicine. 2022;199(106862). ISSN 0954-6111, https://doi.org/10.1016/j.rmed.2022.106862
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 Feb;113(2):93-97. https://doi.org/10.14423/SMJ.0000000000001059. PMID: 32016440
Ptaszynska-Kopczynska K, Kiluk I, Sobkowicz B. Atrial Fibrillation in Patients with Acute Pulmonary Embolism: Clinical Significance and Impact on Prognosis. Biomed Res Int. 2019 Aug 19;2019:7846291. https://doi.org/10.1155/2019/7846291
Kshitij Mahajan, Hizqueel Sami, Akashdeep Singh Grewal, Raheel Ahmed, Hemamalini Sakthivel, Renuka Verma, Abhimanyu Ravalani, Kamleshun Ramphul. Impact of atrial fibrillation on outcomes of patients undergoing ultrasound-assisted catheter-directed thrombolysis following acute pulmonary embolism. Chest. 2024;166(4):A5857. https://doi.org/10.1016/j.chest.2024.06.3469
Kukla P, McIntyre WF, Koracevic G, Kutlesic-Kurtovic D, Fijorek K, Atanaskovic V, Krupa E, Mirek-Bryniarska E, Jastrzębski M, Bryniarski L, Pruszczyk P, Baranchuk A. Relation of atrial fibrillation and right-sided cardiac thrombus to outcomes in patients with acute pulmonary embolism. Am J Cardiol. 2015 Mar 15;115(6):825-30. https://doi.org/10.1016/j.amjcard.2014.12.049
Dang C, Liao W, Xu L, et al. Association between venous thromboembolism and atrial fibrillation: a Mendelian randomization study. BMC Med Genomics. 2024;17(258). https://doi.org/10.1186/s12920-024-02034-y
Liu G, Chen T, Zhang X, et al. Causal effect of atrial fibrillation on pulmonary embolism: a mendelian randomization study. J Thromb Thrombolysis. 2024;57:212-219. https://doi.org/10.1007/s11239-023-02903-w
Pastori D, Gazzaniga G, Farcomeni A, Bucci T, Menichelli D, Franchino G, Pani A, Violi F, Pignatelli P, Fauchier L, Lip GYH. Venous Thromboembolism in Patients With Atrial Fibrillation: A Systematic Review and Meta-Analysis of 4,170,027 Patients. JACC Adv. 2023 Aug 16;2(7):100555. https://doi.org/10.1016/j.jacadv.2023.100555
Liu D, Shi S, Liu X, Ye T, Wang L, Qu C, Yang B, Zhao Q. Retrospective cohort study of new-onset atrial fibrillation in acute pulmonary embolism on prognosis. BMJ Open. 2021 Sep 22;11(9):e047658. https://doi.org/10.1136/bmjopen-2020-047658
Friberg L, Svennberg E. A diagnosis of atrial fibrillation is not a predictor for pulmonary embolism. Thromb Res. 2020 Nov;195:238-242. https://doi.org/10.1016/j.thromres.2020.08.019
Dzikowska-Diduch O, Kurnicka K, Lichodziejewska B, Dudzik-Niewiadomska I, Machowski M, Roik M, Wiśniewska M, Siwiec J, Staniszewska IM, Pruszczyk P. Electrocardiogram, Echocardiogram and NT-proBNP in Screening for Thromboembolism Pulmonary Hypertension in Patients after Pulmonary Embolism. J Clin Med. 2022;11:7369. https://doi.org/10.3390/jcm11247369
Alonso-Martínez JL, Annicchérico-Sánchez FJ, Urbieta-Echezarreta MA, Pérez-Ricarte S. N-terminal Pro-B type natriuretic peptide as long-term predictor of death after an acute pulmonary embolism. Med Clínica. 2015:144(6):241-246. ISSN 0025-7753, https://doi.org/10.1016/j.medcli.2013.11.041
Tzourtzos I, Lakkas L, Katsouras CS. Right Ventricular Longitudinal Strain-Related Indices in Acute Pulmonary Embolism. Medicina. 2024;60:1586. https://doi.org/10.3390/medicina60101586
Dahhan T, Siddiqui I, Tapson VF, et al. Clinical and echocardiographic predictors of mortality in acute pulmonary embolism. Cardiovasc Ultrasound. 2016;14(44). https://doi.org/10.1186/s12947-016-0087-y
Wilson R, Eguchi S, Orihara Y, Pfeiffer M, Peterson B, Ruzieh M, Gao Z, Gorcsan J 3rd, Boehmer J. Association between right ventricular global longitudinal strain and mortality in intermediate-risk pulmonary embolism. Echocardiography. 2024 Apr;41(4):e15815. https://doi.org/10.1111/echo.15815
Vitarelli A, Barillà F, Capotosto L, D’Angeli I, Truscelli G, De Maio M, Ashurov R. Right ventricular function in acute pulmonary embolism: a combined assessment by three-dimensional and speckle-tracking echocardiography. J Am Soc Echocardiogr. 2014 Mar;27(3):329-38. https://doi.org/10.1016/j.echo.2013.11.013
Soulat-Dufour L, Lang S, Evain I, Ederhy S, Chauvet-Droit M, Arnaud C, Fagnen P, Le Bos P, Gerard M, Boccara F, Cohen A. Long term follow up in pulmonary embolism: can right ventricular strain echocardiographic imaging contribute to refine risk stratification? Eur Heart J. Oct 2024;45(1):ehae666.2171. https://doi.org/10.1093/eurheartj/ehae666.2171
Saed Alhakak A, Hauser R, Skaarup KG, Lassen MCH, Johansen ND, Jensen GB, Schnohr P, Mogelvang R, Biering-Sorensen T. The prognostic value of right ventricular longitudinal strain in predicting incident atrial fibrillation and ischemic stroke in the general population. Eur Heart J. Nov 2023;44(2):ehad655.108. https://doi.org/10.1093/eurheartj/ehad655.108
Ji M, Wu W, He L, Gao L, Zhang Y, Lin Y, Qian M, Wang J, Zhang L, Xie M, et al. Right Ventricular Longitudinal Strain in Patients with Heart Failure. Diagnostics. 2022;12:445. https://doi.org/10.3390/diagnostics12020445
Han JM, Xie Q, Song XY, Ma YL. Right atrial volume index and right atrial volume predict atrial fibrillation recurrence: A meta-analysis. PLoS One. 2024 Dec 16;19(12):e0315590. https://doi.org/10.1371/journal.pone.0315590
Ko KY, Jang JH, Choi SH, Baek YS, Kwon SW, Park SD, Woo SI, Kim DH, Shin SH. Impact of right atrial enlargement on clinical outcome in patients with atrial fibrillation. Front Cardiovasc Med. 2022 Sep 23;9:989012. https://doi.org/10.3389/fcvm.2022.989012
Tseluyko VI, Sukhova SM, Yakovleva LM, Kinoshenko KYu. Factors Associated With Unfavorable Long-Term Prognosis in Patients With Acute Pulmonary Embolism. Ukrainian Journal of Cardiology. 2017 Nov;5:75-84. https://www.ucardioj.com.ua/index.php/UJC/article/view/116