Outcome of patients with right heart thrombi: the Right Heart Thrombi European Registry

Abstract

Our aim was the assessment of the prognostic significance of right heart thrombi (RiHT) and their characteristics in pulmonary embolism in relation to established prognostic factors.138 patients (69 females) aged (mean±SD) 62±19 years with RiHT were included into a multicenter registry. A control group of 276 patients without RiHT was created by propensity scoring from a cohort of 963 contemporary patients. The primary end-point was 30-day pulmonary embolism-related mortality; the secondary end-point included 30-day all-cause mortality. In RiHT patients, pulmonary embolism mortality was higher in 31 patients with systolic blood pressure <90 mmHg than in 107 normotensives (42% versus 12%, p=0.0002) and was higher in the 83 normotensives with right ventricular dysfunction (RVD) than in the 24 normotensives without RVD (16% versus 0%, p=0.038). In multivariable analysis the simplified Pulmonary Embolism Severity Index predicted mortality (hazard ratio 2.43, 95% CI 1.58-3.73; p<0.0001), while RiHT characteristics did not. Patients with RiHT had higher pulmonary embolism mortality than controls (19% versus 8%, p=0.003), especially normotensive patients with RVD (16% versus 7%, p=0.02).30-day mortality in patients with RiHT is related to haemodynamic consequences of pulmonary embolism and not to RiHT characteristics. However, patients with RiHT and pulmonary embolism resulting in RVD seem to have worse prognosis than propensity score-matched controls. @ERSpublications Prognosis in patients with PE and RiHT is related to haemodynamic effects of PE, not RiHT morphology

Ocena przebiegu klinicznego u chorych z ostrą zatorowością płucną i skrzeplinami w jamach prawego serca. Doświadczenia jednego ośrodka

“…Previous studies did not report detailed data on the clinical condition of patients treated surgically, so perhaps this treatment was used in critically ill patients, which might explain high mortality associated with surgical treatment. This increase in mortality is also in contrast with the RIHTER registry data which showed a trend towards greater survival in patients treated invasively [7]. Thus, the safety of invasive treatment has not been clearly established but this therapy should be undertaken in patients with RiHT and PFO.…”

“…For the same reason, it is controversial whether RiHT is an independent risk factor of early mortality. The RIHTER registry was an attempt to determine the effect of RiHT on treatment outcomes in patients with acute PE [7]. Data on 138 patients with RiHT were compared th day without RiHT (resolution at day 8), in an improved condition F -female; PE -pulmonary embolism; SBP -systolic blood pressure; HR -heart rate; SI -stroke index [HR/SBP]; rt-PA -recombinant tissue plasminogen activator; HIT -heparin-induced thrombocytopenia; M -male; TEE -transesophageal echocardiography; PFO -patent foramen ovale; BMI -body mass index; MEN I -multiple endocrine neoplasia type 1; LMWH -low-molecular-weight heparin; UFH -unfractionated heparin; VKA -vitamin K antagonist; eGFR -estimated glomerular filtration rate; CNS -central nervous system; NYHA -New York Heart Association; LVEF -left ventricular ejection fraction with a control group that included 276 patients with acute PE.…”

“…In this study, we reported in more details the characteristics and clinical course of patients with PE and RiHT who were investigated and treated in our centre. Some of these findings has been already covered in the summary of the RIHTER registry results [7].…”

“…The multicentre Right Heart Thrombi European Registry (RIHTER) included 138 patients with RiHT to evaluate the prognostic importance of the size, mobility, and shape of RiHT in relation to other prognostic factors in patients with acute PE. This registry showed that patient outcomes depend mostly on the hemodynamic consequences of acute PE and not the shape, size, or mobility of the thrombus [7]. In this study, we reported in more details the characteristics and clinical course of patients with PE and RiHT who were investigated and treated in our centre.…”

Technological Improvements in Cardiac Thrombus Diagnosis

“…Prognosis assessment is very important for therapeutic options and approaches in patients with pulmonary thromboembolism. Several studies reported that patients with RHT and PE had worse prognoses than control groups [60,61]. The International Cooperative Pulmonary Embolism Registry demonstrated that among patients with acute pulmonary thromboembolism, RHT was a marker of worse prognosis in initially apparently stable patients treated with heparin alone [61].…”