title: Relation of atrial fibrillation and right-sided cardiac thrombus to outcomes in patients with acute pulmonary embolism.
abstract: 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.
authors: Department of Internal Medicine and Cardiology, Specialistic Hospital, Gorlice, Poland. Electronic address: kukla_piotr@poczta.onet.pl.
authors: Piotr
authors: P
authors: Kukla
authors: Section of Cardiology, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
authors: Wiliam F
authors: WF
authors: McIntyre
authors: Department for Cardiovascular Diseases, Clinical Center, Nis, Serbia.
authors: Goran
authors: G
authors: Koracevic
authors: Department for Cardiovascular Diseases, Clinical Center, Nis, Serbia.
authors: Dusanka
authors: D
authors: Kutlesic-Kurtovic
authors: Department of Statistics, Cracow University of Economics, Cracow, Poland.
authors: Kamil
authors: K
authors: Fijorek
authors: Department for Cardiovascular Diseases, Clinical Center, Nis, Serbia.
authors: Vesna
authors: V
authors: Atanaskovic
authors: Department of Cardiology, Szczeklik Specialistic Hospital, Tarnów, Poland.
authors: Ewa
authors: E
authors: Krupa
authors: Department of Cardiology, Dietl Specialistic Hospital, Cracow, Poland.
authors: Ewa
authors: E
authors: Mirek-Bryniarska
authors: First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Cracow, Poland.
authors: Marek
authors: M
authors: Jastrzębski
authors: First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Cracow, Poland.
authors: Leszek
authors: L
authors: Bryniarski
authors: Department of Internal Medicine and Cardiology, Medical University of Warsaw, Poland.
authors: Piotr
authors: P
authors: Pruszczyk
authors: Division of Cardiology, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada.
authors: Adrian
authors: A
authors: Baranchuk
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D002170:Canada / Q000453:epidemiology; D005260:Female; D006325:Heart Atria / Q000473:pathology; D006801:Humans; D015994:Incidence; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D011044:Poland / Q000453:epidemiology; D015995:Prevalence; D011379:Prognosis; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology* / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D013927:Thrombosis / Q000150:complications* / Q000401:mortality