Right heart thrombi in pulmonary embolism patients

Introduction: There is a lack of comprehensive data on the prevalence, predictors and prognostic significan-ce of right heart thrombus (RHT) in acute pulmonary embolism (APE). Therapeutic options in these patients consist of anticoagulation, thrombolysis or surgical embolectomy, but the optimal management remains controversial.

Methods: T he lot consisted of 120 patients consecu-tively hospitalized in the Cardiology Clinic of the „Sf. Pantelimon“ Emergency Clinical Hospital Bucharest between January 2014 and March 2019.

Results: The mean age of the study group was 68.3 ± 12.5 years, with 63.3% female patients. Of the 120 pati-ents with APE, 14.9% (n=16) presented with RHT. The mean age of RHT patients was 69.1 ± 12 years, with no differences in gender distribution. We have not identified significant differences in risk factors, onset symptoms or hemodynamic status. The values of tro-ponin I or natriuretic peptides were similar along with electrocardiographic and echocardiographic data. The presence of DVT was significantly higher in patients with RHT (OR=9.9, CI 95% 2.1-46, p=0.001). PESI score was higher in the RHT group but without statis-tical significance (112.2 vs. 105.7, p=0.5). In the group of patients with RHT the mean duration of hospitaliza-tion was significantly higher (14.6 days vs. 10.6 days, p =0.008) and thrombolysis was administered to 4 pati-ents, similar to those without chamber thrombosis. In our group, RHT did not associate with a higher mortality during hospitalization.

Conclusions: Right heart thrombus in patients with APE are relatively rare finding in current practice. Beyond the ease of diagnosis using echocardiography, there remains uncertainty about their role in the thera-peutic decision. We recommend individual risk assess-ment and the subsequent adjustment of the intensity and type of therapy.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)