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New-Onset Paroxysmal Atrial Fibrillation in the Setting of Acute Pulmonary Embolism Is Associated with All-Cause Hospital Mortality in Women but Not in Men

Background: Patients with acute pulmonary embolism (PE) may have various types of atrial fibrillation (AF). The role of AF in hemodynamic states and outcomes may differ between men and women. Methods: In total, 1600 patients (743 males and 857 females) with acute PE were enrolled in this study. The...

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Autores principales: Djuric, Ivica, Dzudovic, Boris, Subotic, Bojana, Dzudovic, Jelena, Matijasevic, Jovan, Benic, Marija, Salinger, Sonja, Mitevska, Irena, Kos, Ljiljana, Kovacevic-Preradovic, Tamara, Simovic, Stefan, Miloradovic, Vladimir, Savicic, Tanja, Bozovic, Bjanka, Bulatovic, Nebojsa, Kafedzic, Srdjan, Neskovic, Aleksandar N., Kocev, Nikola, Marinković, Jelena, Obradovic, Slobodan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10252450/
https://www.ncbi.nlm.nih.gov/pubmed/37296681
http://dx.doi.org/10.3390/diagnostics13111829
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author Djuric, Ivica
Dzudovic, Boris
Subotic, Bojana
Dzudovic, Jelena
Matijasevic, Jovan
Benic, Marija
Salinger, Sonja
Mitevska, Irena
Kos, Ljiljana
Kovacevic-Preradovic, Tamara
Simovic, Stefan
Miloradovic, Vladimir
Savicic, Tanja
Bozovic, Bjanka
Bulatovic, Nebojsa
Kafedzic, Srdjan
Neskovic, Aleksandar N.
Kocev, Nikola
Marinković, Jelena
Obradovic, Slobodan
author_facet Djuric, Ivica
Dzudovic, Boris
Subotic, Bojana
Dzudovic, Jelena
Matijasevic, Jovan
Benic, Marija
Salinger, Sonja
Mitevska, Irena
Kos, Ljiljana
Kovacevic-Preradovic, Tamara
Simovic, Stefan
Miloradovic, Vladimir
Savicic, Tanja
Bozovic, Bjanka
Bulatovic, Nebojsa
Kafedzic, Srdjan
Neskovic, Aleksandar N.
Kocev, Nikola
Marinković, Jelena
Obradovic, Slobodan
author_sort Djuric, Ivica
collection PubMed
description Background: Patients with acute pulmonary embolism (PE) may have various types of atrial fibrillation (AF). The role of AF in hemodynamic states and outcomes may differ between men and women. Methods: In total, 1600 patients (743 males and 857 females) with acute PE were enrolled in this study. The severity of PE was assessed using the European Society of Cardiology (ESC) mortality risk model. Patients were allocated into three groups according to their electrocardiography recordings taken during hospitalization: sinus rhythm, new-onset paroxysmal AF, and persistent/permanent AF. The association between the types of AF and all-cause hospital mortality was tested using regression models and net reclassification index (NRI) and integrated discrimination index (IDI) statistics with respect to sex. Results: There were no differences between the frequencies of the types of AF between men and women: 8.1% vs. 9.1% and 7.5% vs. 7.5% (p = 0.766) for paroxysmal and persistent/permanent AF, respectively. We found that the rates of paroxysmal AF significantly increased across the mortality risk strata in both sexes. Among the types of AF, the presence of paroxysmal AF had a predictive value for all-cause hospital mortality independent of mortality risk and age in women only (adjusted HR, 2.072; 95% CI, 1.274–3.371; p = 0.003). Adding paroxysmal AF to the ESC risk model did not improve the reclassification of patient risk for the prediction of all-cause mortality, but instead enhanced the discriminative power of the existing model in women only (NRI, not significant; IDI, 0.022 (95% CI, 0.004–0.063); p = 0.013). Conclusion: The occurrence of paroxysmal AF in female patients with acute PE has predictive value for all-cause hospital mortality independent of age and mortality risk.
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spelling pubmed-102524502023-06-10 New-Onset Paroxysmal Atrial Fibrillation in the Setting of Acute Pulmonary Embolism Is Associated with All-Cause Hospital Mortality in Women but Not in Men Djuric, Ivica Dzudovic, Boris Subotic, Bojana Dzudovic, Jelena Matijasevic, Jovan Benic, Marija Salinger, Sonja Mitevska, Irena Kos, Ljiljana Kovacevic-Preradovic, Tamara Simovic, Stefan Miloradovic, Vladimir Savicic, Tanja Bozovic, Bjanka Bulatovic, Nebojsa Kafedzic, Srdjan Neskovic, Aleksandar N. Kocev, Nikola Marinković, Jelena Obradovic, Slobodan Diagnostics (Basel) Article Background: Patients with acute pulmonary embolism (PE) may have various types of atrial fibrillation (AF). The role of AF in hemodynamic states and outcomes may differ between men and women. Methods: In total, 1600 patients (743 males and 857 females) with acute PE were enrolled in this study. The severity of PE was assessed using the European Society of Cardiology (ESC) mortality risk model. Patients were allocated into three groups according to their electrocardiography recordings taken during hospitalization: sinus rhythm, new-onset paroxysmal AF, and persistent/permanent AF. The association between the types of AF and all-cause hospital mortality was tested using regression models and net reclassification index (NRI) and integrated discrimination index (IDI) statistics with respect to sex. Results: There were no differences between the frequencies of the types of AF between men and women: 8.1% vs. 9.1% and 7.5% vs. 7.5% (p = 0.766) for paroxysmal and persistent/permanent AF, respectively. We found that the rates of paroxysmal AF significantly increased across the mortality risk strata in both sexes. Among the types of AF, the presence of paroxysmal AF had a predictive value for all-cause hospital mortality independent of mortality risk and age in women only (adjusted HR, 2.072; 95% CI, 1.274–3.371; p = 0.003). Adding paroxysmal AF to the ESC risk model did not improve the reclassification of patient risk for the prediction of all-cause mortality, but instead enhanced the discriminative power of the existing model in women only (NRI, not significant; IDI, 0.022 (95% CI, 0.004–0.063); p = 0.013). Conclusion: The occurrence of paroxysmal AF in female patients with acute PE has predictive value for all-cause hospital mortality independent of age and mortality risk. MDPI 2023-05-23 /pmc/articles/PMC10252450/ /pubmed/37296681 http://dx.doi.org/10.3390/diagnostics13111829 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Djuric, Ivica
Dzudovic, Boris
Subotic, Bojana
Dzudovic, Jelena
Matijasevic, Jovan
Benic, Marija
Salinger, Sonja
Mitevska, Irena
Kos, Ljiljana
Kovacevic-Preradovic, Tamara
Simovic, Stefan
Miloradovic, Vladimir
Savicic, Tanja
Bozovic, Bjanka
Bulatovic, Nebojsa
Kafedzic, Srdjan
Neskovic, Aleksandar N.
Kocev, Nikola
Marinković, Jelena
Obradovic, Slobodan
New-Onset Paroxysmal Atrial Fibrillation in the Setting of Acute Pulmonary Embolism Is Associated with All-Cause Hospital Mortality in Women but Not in Men
title New-Onset Paroxysmal Atrial Fibrillation in the Setting of Acute Pulmonary Embolism Is Associated with All-Cause Hospital Mortality in Women but Not in Men
title_full New-Onset Paroxysmal Atrial Fibrillation in the Setting of Acute Pulmonary Embolism Is Associated with All-Cause Hospital Mortality in Women but Not in Men
title_fullStr New-Onset Paroxysmal Atrial Fibrillation in the Setting of Acute Pulmonary Embolism Is Associated with All-Cause Hospital Mortality in Women but Not in Men
title_full_unstemmed New-Onset Paroxysmal Atrial Fibrillation in the Setting of Acute Pulmonary Embolism Is Associated with All-Cause Hospital Mortality in Women but Not in Men
title_short New-Onset Paroxysmal Atrial Fibrillation in the Setting of Acute Pulmonary Embolism Is Associated with All-Cause Hospital Mortality in Women but Not in Men
title_sort new-onset paroxysmal atrial fibrillation in the setting of acute pulmonary embolism is associated with all-cause hospital mortality in women but not in men
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10252450/
https://www.ncbi.nlm.nih.gov/pubmed/37296681
http://dx.doi.org/10.3390/diagnostics13111829
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