Harvard Medical School, Boston, Mass; Smith Center for Outcomes Research in Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Mass.
Harvard Medical School, Boston, Mass; Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Mass.
Am J Med. 2023 Nov;136(11):1109-1118.e3. doi: 10.1016/j.amjmed.2023.07.014. Epub 2023 Aug 11.
Right heart thrombus is a rare but serious form of venous thromboembolic disease that may be associated with pulmonary embolism. The prognosis of patients with right heart thrombus presenting without a concomitant pulmonary embolism remains ill-defined.
We conducted a multi-center observational cohort study to compare patients presenting with right heart thrombus with and without a concurrent pulmonary embolism. The primary endpoint was 90-day all-cause mortality. Multivariable regression was utilized to assess primary and secondary outcomes.
Of 231 patients with right heart thrombus, 104 (45.0%) had a pulmonary embolism at admission. The median age of the cohort was 59.4 years (interquartile range 44.9-71.3). Pulmonary embolism in the setting of a right heart thrombus was associated with an increased adjusted hazard of 90-day mortality (hazard ratio 3.68; 95% confidence interval [CI], 1.51-8.97). Additionally, these patients had a higher adjusted risk of in-hospital mortality (odds ratio [OR] 2.55; 95% CI, 1.15-5.94) and admission to the intensive care unit (OR 2.45; 95% CI, 1.23-4.94). Thrombus mobility (OR 2.99; 95% CI, 1.35-6.78) and larger thrombus sizes (OR 1.04; 95% CI, 1.00-1.07) were associated with development of concurrent pulmonary embolism.
Patients with right heart thrombus and pulmonary embolism had a more severe clinical presentation, required more advanced therapies, and had reduced survival compared with those without a concomitant pulmonary embolism. Important variables associated with development of concomitant pulmonary embolism include thrombus mobility and size. Right heart thrombus in the setting of acute pulmonary embolism represents a unique clinical entity that is associated with worse prognosis compared with right heart thrombus only.
右心血栓是一种罕见但严重的静脉血栓栓塞疾病，可能与肺栓塞有关。无伴发肺栓塞的右心血栓患者的预后仍不明确。
我们进行了一项多中心观察性队列研究，比较了有和无伴发肺栓塞的右心血栓患者。主要终点为 90 天全因死亡率。采用多变量回归评估主要和次要结局。
在 231 例右心血栓患者中，104 例（45.0%）入院时合并肺栓塞。队列的中位年龄为 59.4 岁（四分位距 44.9-71.3）。右心血栓伴肺栓塞与 90 天死亡率增加的校正风险比相关（风险比 3.68；95%置信区间[CI]，1.51-8.97）。此外，这些患者的院内死亡率（比值比[OR] 2.55；95%CI，1.15-5.94）和入住重症监护病房（OR 2.45；95%CI，1.23-4.94）的风险更高。血栓活动性（OR 2.99；95%CI，1.35-6.78）和更大的血栓大小（OR 1.04；95%CI，1.00-1.07）与伴发肺栓塞的发生相关。
与无伴发肺栓塞的患者相比，有右心血栓和肺栓塞的患者临床表现更严重，需要更先进的治疗，生存率更低。与伴发肺栓塞发生相关的重要变量包括血栓活动性和大小。急性肺栓塞伴右心血栓代表一种独特的临床实体，与单纯右心血栓相比预后更差。
