Atrial fibrillation as prognostic factor in patients with pulmonary embolism

Abstract

The aim – to analyze the clinical course and prognostic factors in patients with pulmonary embolism (PE) and concomitant atrial fibrillation (AF).
Materials and methods. We analyzed 243 medical cards of patients with diagnosis «PE» who were hospitalized to Kharkiv City Clinical Hospital No.8. during 01.01.2018 – 01.01.2020 period. The inclusion criteria was diagnosis «PE» verified by multispiral computed tomography angiography (CTPA) of pulmonary arteries and/or by autopsy. Patients were divided in several groups: 1 – PE with AF (45 pts – 18.5 %), 2 – PE with no AF (198 pts – 81.5 %). Patients from group 1 were divided in such subgroups as: 1А – PE + AF de novo (22 pts – 48.8 %); 1В – PE + AF existing before acute PE (23 pts – 51.2 %). Clinical, anamnestic, biochemical, instrumental parameters, mortality rates were measured; statistical analysis was done.
Results and discussion. Pts from group 1 were older (67.2±10.6 vs 58.6±14.6), had more cases of ischemic strokes in past. By admission to hospital most of high-risk patients were among group 1. We noticed that patients from group 1 who had low-risk profile also had respectively higher points measured by PESI. Patients with PE + AF had respectively lower saturation and higher heart rate; granulocyte count and serum creatinine ration. Several parameters measured with CTPA and echocardiography differed significantly in PE + AF and PE without AF groups: diameter pulmonary trunk; diameter of pulmonary arteries, size of the left and right atrium, left ventricle (LV) end diastolic diameter, LV end systolic diameter, LV ejection fraction and mean pulmonary arterial pressure (PAP). There were several differences between 1A and 1B groups: patients with PE + AF existing before had more cases of ischemic stroke. High-risk status was much common among patients with PE + AF de novo despite the fact that all patients with PE + AF with low-risk status had high points and classes measured with PESI. We noticed that patients with PE + AF had also respectively differences in granulocyte count and serum creatinine. There were also differences in echocardiographic parameters as size of left atrium (bigger in group 1B) while mean PAP was much bigger in group 1A. It should be mentioned that general mortality rate was 18.5 %, while there were big differences between mortality rates in groups 2 and 1 (13.6 % vs 44.4 %). Mortality rate differed significantly in patients with PE + AF de novo and PE + AF existing before (67.5 % vs 21.7 %). We used uni- and multivariate analyses to find out prognostic factors (AF is among them).
Conclusions. AF was found in 18.5 % of patients with PE, AF de novo – in 9 %. Patients with PE + AF were 8.6 years older than patients with PE without AF. Vein thrombosis is less common among patients with PE + AF. Patients with PE + AF have larger sizes of left and right atrium and more poor ejection fraction of left ventricle. AF, as age, blood saturation, obesity, PESI score, is independent prognostic factor of adverse clinical outcome. Performed by Kaplan – Meier AF de novo has the most adverse impact on prognosis in the nearest time period for patients with PE.