Prediction of new onset atrial fibrillation in patients with acute pulmonary embolism: The role of sPESI Score.

OBJECTIVE: Acute pulmonary embolism (APE) is a serious clinical situation and atrial fibrillation (AF) is the most common arrhytmia in clinical practice. The Pulmonary Embolism Severity Index (PESI) is an accepted risk stratification tool used to predict short term mortality in APE. The aim of this study was to evaluate the relationship between the PESI score and new-onset AF in patients with APE. METHODS: The records of 869 APE patients admitted between May 2012 and December 2015 were evaluated retrospectively. The PESI score was calculated for every patient. Clinical variables associated with new-onset AF in APE were assessed after the exclusion of patients with hypertension, coronary or hemodynamically significant valvular heart disease, hepatic or renal dysfunction, chronic obstructive pulmonary disease, thyroid dysfunction, diabetes mellitus, sleep apnea, any history of inflammatory or infectious disease, or recent trauma. New-onset AF was detected in 42 (4.8%) patients. RESULTS: Age, gender, systolic and diastolic blood pressure, heart rate, fasting glucose level, serum creatinine, left ventricle ejection fraction, tricuspid annular plane systolic excursion value, and pulmonary artery systolic pressure measures were not significantly different between patients with and without AF. New-AF patients demonstrated larger LVEDD and LAD dimensions (p <0.001 for both). The PESI score was higher in the new-onset AF group (93+-23 vs.75+-17; p <0.001). LVEDD, LAD, levels of uric acid, bilirubin, albumin, and troponin, and PESI score were univariate predictors of new-onset AF. CONCLUSION: In patients with APE, the PESI score was positively correlated with new-onset AF. A PESI score greater than 82.50 may be useful to predict new-onset AF in these patients.

The relationship between right ventricular outflow tract fractional shortening and Pulmonary Embolism Severity Index in acute pulmonary embolism.

OBJECTIVE: Right ventricular (RV) functions are clinically important in acute pulmonary embolism (APE). Measurement of systolic function of the right ventricular outflow tract (RVOT) with echocardiography is a simple method to evaluate RV function. The aim of this study was to determine the relationship between RVOT systolic function and the Pulmonary Embolism Severity Index (PESI). METHODS: A total of 151 patients diagnosed with APE by pulmonary computed tomography angiography or ventilation/perfusion scintigraphy were included. Patients were assigned to 2 groups based on the simplified PESI (sPESI): sPESI <1 (n=85) and sPESI ≥1 (n=66). RV conventional parameters, RVOT dimensions, and fractional shortening (RVOT-FS) were also measured. RESULTS: Mean age was similar between sPESI <1 and >1 patients (58.7±12.9 years vs. 61.1±12.7 years, respectively). Frequency of male gender was significantly higher in PESI <1 group (61.2% vs. 40.2%, p=0.013). No significant differences were found between the groups in fasting glucose, serum creatinine, hemoglobin, C-reactive protein, erythrocyte sedimentation rate, troponin, and D-dimer levels, and left ventricular ejection fraction. RVOT-FS was higher in patients with sPESI <1 than in patients with sPESI ≥1 (34.41±3.56 vs. 22.98±4.22), and this difference was significant (p<0.001). Tricuspid annular plane systolic excursion values were lower and pulmonary artery systolic pressure values were higher in the sPESI ≥1 group, which was also statistically significant (p<0.05). Mortality occurred in 7 patients with sPESI <1 and in 16 patients with sPESI ≥1. The mortality rate was higher in patients with lower RVOT-FS, and a RVOT-FS <0.22 predicted mortality with a sensitivity of 54.5% (AUC: 0.674, 95% CI 0.552-0.796; p=0.009). CONCLUSION: The RVOT-FS is a noninvasive measurement of RV systolic function, is well-correlated with the sPESI score, and associated with mortality in patients with APE. This easily applied measurement may be used to predict short-term mortality in patients with APE.

Left ventricular pseudoaneurysm after mitral valve replacement: Review of pseudoaneurysms late after mitral valve replacement.

Left ventricular pseudoaneurysm (LVPA) due to incomplete or late rupture after mitral valve replacement is a rare condition but can be life threatening if it develops into perdicardial tamponade. LVPA may develop de novo after the surgical procedure or may be a sequela of an earlier rupture. Clinical presentation includes shortness of breath, heart failure, chest pain, endocarditis, and pericardial tamponade. However, it can also have an asymptomatic course. The recommended treatment for LVPA is surgical repair. Conservative follow-up is an alternative for patients who refuse surgical treatment or are considered high risk for re-operation. We conducted a review of all the available literature on cases of LVPA after mitral valve replacement and present the findings here.