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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...
Autores principales: | , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2023
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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. |
format | Online Article Text |
id | pubmed-10252450 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
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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