Kukla Piotr, McIntyre Wiliam F, Koracevic Goran, Kutlesic-Kurtovic Dusanka, Fijorek Kamil, Atanaskovic Vesna, Krupa Ewa, Mirek-Bryniarska Ewa, Jastrzębski Marek, Bryniarski Leszek, Pruszczyk Piotr, Baranchuk Adrian
Department of Internal Medicine and Cardiology, Specialistic Hospital, Gorlice, Poland.
Section of Cardiology, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Am J Cardiol. 2015 Mar 15;115(6):825-30. doi: 10.1016/j.amjcard.2014.12.049. Epub 2015 Jan 6.
Atrial fibrillation (AF) can induce a hypercoagulable state in both the left and right atria. Thrombus in the right side of the heart (RHT) may lead to acute pulmonary embolism (APE). The aim of the study was to determine the prevalence of RHT and AF and to assess their impact on outcomes in patients with APE. The retrospective cohort included 1,006 patients (598 female), with a mean age of 66 ± 15 years. The primary end point was all-cause mortality. The secondary end point was incidence of complications (death, cardiogenic shock, cardiac arrest, vasopressor/inotrope treatment, or ventilatory support). Atrial fibrillation was detected in 231 patients (24%). RHT was observed in 50 patients (5%). The combination of AF and RHT was observed in 16 patients (2%). The overall mortality rate was significantly higher in patients with RHT compared with those without (32% vs 14%, respectively, odds ratio [OR] 3.0, 95% confidence interval [CI] 1.6 to 5.6, p = 0.001). The rate of complications was significantly higher in patients with RHT in comparison to those without (40% vs 22%, respectively, OR 2.4, 95% CI 1.3 to 4.4, p = 0.004). The mortality rate in patients with both AF and RHT was significantly higher in comparison to those with AF but without RHT (50% vs 20%, respectively, OR 3.86, 95% CI 1.3 to 11.2, p = 0.01). In multivariate analysis, RHT (p = 0.03) was an independent predictor of death. In conclusion, AF is a frequent co-morbidity in patients with APE, and the presence of RHT is not uncommon. Among patients with APE, the presence of RHT increases the mortality approximately threefold regardless of the presence of known AF.
心房颤动（AF）可在左、右心房诱发高凝状态。右心血栓（RHT）可能导致急性肺栓塞（APE）。本研究的目的是确定RHT和AF的患病率，并评估它们对APE患者预后的影响。回顾性队列研究纳入了1006例患者（598例女性），平均年龄为66±15岁。主要终点是全因死亡率。次要终点是并发症的发生率（死亡、心源性休克、心脏骤停、血管加压药/正性肌力药治疗或通气支持）。231例患者（24%）检测到心房颤动。50例患者（5%）观察到RHT。16例患者（2%）观察到AF和RHT同时存在。与无RHT的患者相比，有RHT的患者总体死亡率显著更高（分别为32%和14%，优势比[OR]3.0，95%置信区间[CI]1.6至5.6，p = 0.001）。与无RHT的患者相比，有RHT的患者并发症发生率显著更高（分别为40%和22%，OR 2.4，95%CI 1.3至4.4，p = 0.004）。与有AF但无RHT的患者相比，同时有AF和RHT的患者死亡率显著更高（分别为50%和20%，OR 3.86，95%CI 1.3至11.2，p = 0.01）。在多变量分析中，RHT（p = 0.03）是死亡的独立预测因素。总之，AF是APE患者常见的合并症，RHT的存在并不罕见。在APE患者中，无论是否存在已知的AF，RHT的存在都会使死亡率增加约三倍。
