Li Wen, Liu Zhi-Ying, Chen Xiao-Xi, Qian Yu-Ling, Quan Rui-Lin, Xiong Chang-Ming, Gu Qing, He Jian-Guo
State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China.
State Key Laboratory of Cardiovascular Disease, Center of Pulmonary Vascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China.
Pulm Circ. 2023 Sep 20;13(3):e12291. doi: 10.1002/pul2.12291. eCollection 2023 Jul.
Right heart thrombus (RHT) is a rare but life-threatening condition in acute pulmonary embolism (APE) without clear management guidelines. This study aimed to address the clinical characteristics and outcomes of RHT-APE in Chinese patients. In this study, 17 RHT-APE and 329 non-RHT-APE patients, who were diagnosed between September 2015 and August 2019, were retrospectively recruited with the median follow-up was 360 days. The overall prevalence of RHT was 4.91% in APE. Its prevalence increased along the increase of APE risk stratifications. Comparisons showed that with higher proportion of male gender and younger age, RHT-APE patients also had worse hemodynamic instability and heart function, and higher risk stratification levels than non-RHT-APE patients. After adjusting by age and gender, multivariate logistic regression analysis found high/intermediate-high risk stratification, decreased right ventricular (RV) motion, NT-proBNP >600 pg/mL, and RV dysfunction were risk factors for RHT. Kaplan-Meier analysis showed non-RHT had better prognosis than RHT patients (30-day survival: log-rank: < 0.001; 90-day survival: log-rank: = 0.002). The multivariate logistic regression analysis showed RHT was an independent risk factor for 30-day mortality in APE. The subgroup analysis showed RHT would result in worse outcomes in patients who already had higher APE early mortality risk. RHT would increase the risk of 30- and 90-day mortality in APE. More attention should be paid to young male APE patients with decreased RV motion, NT-proBNP >600 pg/mL, RV dysfunction, or high level of risk stratification, to exclude the coexistence of RHT.
右心血栓（RHT）在急性肺栓塞（APE）中较为罕见，但却危及生命，目前尚无明确的管理指南。本研究旨在探讨中国APE患者合并RHT的临床特征及预后。本研究回顾性纳入了2015年9月至2019年8月期间诊断的17例RHT-APE患者和329例非RHT-APE患者，中位随访时间为360天。APE患者中RHT的总体患病率为4.91%。其患病率随APE风险分层的增加而升高。比较显示，RHT-APE患者男性比例更高、年龄更小，血流动力学不稳定和心功能也更差，风险分层水平高于非RHT-APE患者。在对年龄和性别进行校正后，多因素logistic回归分析发现高/中高风险分层、右心室（RV）运动减弱、NT-proBNP>600 pg/mL以及RV功能障碍是RHT的危险因素。Kaplan-Meier分析显示，非RHT患者的预后优于RHT患者（30天生存率：对数秩检验：<0.001；90天生存率：对数秩检验：=0.002）。多因素logistic回归分析显示，RHT是APE患者30天死亡率的独立危险因素。亚组分析显示，RHT会使早期APE死亡风险较高的患者预后更差。RHT会增加APE患者30天和90天死亡率的风险。对于RV运动减弱、NT-proBNP>600 pg/mL、RV功能障碍或风险分层水平高的年轻男性APE患者，应更加关注，以排除合并RHT的情况。
