Krajewska Agnieszka, Ptaszynska-Kopczynska Katarzyna, Kiluk Izabela, Kosacka Urszula, Milewski Robert, Krajewski Jacek, Musial Wlodzimierz Jerzy, Sobkowicz Bozena
Department of Cardiology, Medical University of Białystok, Białystok, Poland.
Department of Cardiology, Procardia, Augustów, Poland.
Biomed Res Int. 2017;2017:5049802. doi: 10.1155/2017/5049802. Epub 2017 Feb 9.
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. . 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. . Paroxysmal AF patients were the oldest. Concomitant DVT varies between groups: paroxysmal AF 32.3%, SR 49.5%, and permanent AF 28.1% ( = 0.02). The stroke history frequency was 4.6% SR, 12.9% paroxysmal AF, and 21.9% permanent AF ( < 0.001). Paroxysmal AF comparing to permanent AF and SR individuals had higher estimated SPAP (56 versus 48 versus 47 mmHg, = 0.01) and shorter ACT (58 versus 65 versus 70 ms, = 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%) ( < 0.001). . 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.
急性肺栓塞（PE）中房颤（AF）的关系及临床意义研究较少。我们旨在分析阵发性房颤发作的PE患者的临床特征及预后。从391例PE患者中选取31例阵发性房颤患者。将该组患者与PE合并窦性心律（SR）患者及32例PE合并永久性房颤患者进行比较。阵发性房颤患者年龄最大。各组间合并深静脉血栓（DVT）情况不同：阵发性房颤组为32.3%，SR组为49.5%，永久性房颤组为28.1%（P = 0.02）。卒中病史发生率在SR组为4.6%，阵发性房颤组为12.9%，永久性房颤组为21.9%（P < 0.001）。与永久性房颤和SR个体相比，阵发性房颤患者的估计肺动脉收缩压（SPAP）更高（分别为56 mmHg、48 mmHg和47 mmHg，P = 0.01），活化凝血时间（ACT）更短（分别为58 ms、65 ms和70 ms，P = 0.04）。根据改良日内瓦评分和简化肺栓塞严重性指数（sPESI），房颤患者比SR患者更常被归类为高危组。与永久性房颤组（25%）相比，SR组（5%）和阵发性房颤组（6.5%）的院内死亡率更低（P < 0.001）。PE相关阵发性房颤患者构成一个单独的群体。反映右心室后负荷的参数更严重受损可能表明PE严重程度与阵发性房颤发作之间的关系。阵发性房颤对短期死亡率无影响。
