Contemporary echocardiographic assessment of atrial appendages in non-valvular atrial fibrillation

Lohvinov, Y.; Mikhaliev, K.O.; Zharinov, O.

doi:10.5603/kp.2015.0162

Cited by 4 publications

(9 citation statements)

References 58 publications

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“…AF may be not only a consequence of PE but also a risk factor for PE. It induces the prothrombotic state due to activation of the coagulation cascade and platelets [ 13 ]. Lack of atrial contraction results in blood stasis and possibility of thrombus formation in both atria, particularly in their appendages [ 14 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

Paroxysmal Atrial Fibrillation in the Course of Acute Pulmonary Embolism: Clinical Significance and Impact on Prognosis

Krajewska

Ptaszyńska‐Kopczyńska

Kiluk

et al. 2017

BioMed Research International

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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. Methods. 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. Results. Paroxysmal AF patients were the oldest. Concomitant DVT varies between groups: paroxysmal AF 32.3%, SR 49.5%, and permanent AF 28.1% (p = 0.02). The stroke history frequency was 4.6% SR, 12.9% paroxysmal AF, and 21.9% permanent AF (p < 0.001). Paroxysmal AF comparing to permanent AF and SR individuals had higher estimated SPAP (56 versus 48 versus 47 mmHg, p = 0.01) and shorter ACT (58 versus 65 versus 70 ms, p = 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%) (p < 0.001). Conclusions. 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.

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Section: Discussionmentioning

confidence: 99%

Paroxysmal Atrial Fibrillation in the Course of Acute Pulmonary Embolism: Clinical Significance and Impact on Prognosis

Krajewska

Ptaszyńska‐Kopczyńska

Kiluk

et al. 2017

BioMed Research International

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“…Blood stasis observed in both atria during AF as well as the anatomical morphology of atrial appendages filled with rough pectinate muscles facilitates thrombus formation. Thrombus formation within the left atrium (LA), particularly in the LA appendage (LAA), and systemic embolization have been well documented in patients with AF [9]. Thus, it may be assumed that thrombus formation in the right atrium (RA), particularly in the RA appendage (RAA), is possible in patients with AF and may cause PE.…”

Section: Atrial Fibrillation As a Risk Factor For Pulmonary Embolismmentioning

confidence: 99%

“…Large-scale population-based studies have provided a considerable body of evidence on the involvement of PE in the onset of subsequent AF [3, 9, 30]. The increased risk of late-onset AF has been observed in patients after acute PE during long-term follow-up [24].…”

Section: Atrial Fibrillation As a Consequence Of Pulmonary Embolismmentioning

confidence: 99%

Atrial Fibrillation in Patients with Acute Pulmonary Embolism: Clinical Significance and Impact on Prognosis

Ptaszyńska‐Kopczyńska

Kiluk

Sobkowicz

2019

BioMed Research International

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Pulmonary embolism (PE) is one of the most common causes of cardiovascular death. The most often PE etiology is a deep vein thrombosis (DVT) of the lower extremities, but embolic material can arise in pelvic or upper extremity veins as well as in right heart chambers. There is growing number of evidences of atrial fibrillation (AF) involvement in PE. The presence of AF in patients with PE may be both the cause and the consequence of PE. The PE association with AF should be considered in patients without confirmed DVT and with history of AF, which itself is associated with prothrombotic state. The valuable diagnostic method is echocardiography that may bring the insight into source of embolic material. Another possible AF and PE association is the AF as a consequence of an abrupt increase in pulmonary vascular resistance due to the occlusion of the pulmonary vessels. Large-scale population-based studies have provided a considerable body of evidence on the involvement of PE in the onset of subsequent AF. Another important issue is the influence of AF on prognosis in patients with PE. Most investigators demonstrated a negative impact of AF on mortality. The main problem to resolve is whether AF is an independent mortality risk factor or whether it occurs as a result of comorbidities or the severity of a PE episode. Although the pathophysiological basis of this bidirectional relationship exists, many questions are still unresolved and require further studies, including the significance of paroxysmal AF accompanying an acute PE episode, the usefulness of PE risk scales in patients with concomitant AF, and the effect of anticoagulant treatment on PE and AF occurrence. Regardless of the type of AF, clinicians should be alert to the possibility of PE in patients with previous history of AF or presenting with new-onset AF.

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“…Some studies showed that AF was associated with endothelial dysfunction that was ameliorated after sinus rhythm restoration. 16,17 The presence of AF inducing a hypercoagulable state and increased platelet aggregation was shown in several studies, 18,19 and it would be reasonable to infer that both the right and left atria are in a hypercoagulable state. At the same time, the atrium loses effective contractile function, leading to local blood stasis, which increases the risk of atrial thrombosis.…”

Section: Discussionmentioning

confidence: 97%

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

Jing

Tang

et al. 2020

Semin Thromb Hemost

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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.

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Contemporary echocardiographic assessment of atrial appendages in non-valvular atrial fibrillation

Cited by 4 publications

References 58 publications

Paroxysmal Atrial Fibrillation in the Course of Acute Pulmonary Embolism: Clinical Significance and Impact on Prognosis

Paroxysmal Atrial Fibrillation in the Course of Acute Pulmonary Embolism: Clinical Significance and Impact on Prognosis

Atrial Fibrillation in Patients with Acute Pulmonary Embolism: Clinical Significance and Impact on Prognosis

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

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