Thromboembolic findings in patients with heart failure at autopsy

Macêdo, Isabella Sales de; Dinardi, Layara Fernanda Lipari; Pereira, Thales; Almeida, Lana Carneiro; Barbosa, Thaisa Silveira; Benvenuti, Luiz Alberto; Ayub‐Ferreira, Silvia Moreira; Bocchi, Edimar Alcides; Issa, Victor Sarli

doi:10.1016/j.carpath.2018.04.004

Cited by 10 publications

(6 citation statements)

References 21 publications

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“…Detailed echocardiography for each patient was not reported. In one study, the mean left ventricular ejection fraction (LVEF) of all patients with CHF included in the investigation was 42.1

18.7% [ 24 ]. In another study, an asymptomatic patient with right bundle branch block in the resting ECG, normal chest X-ray, right ventricular dilatation, right ventricular hypokinesia, and right atrial enlargement at transthoracic echocardiogram was also found to have a massive right atrium thrombus [ 25 ] with no episode of PE.…”

Section: Clinical Radiological Electrocardiographic and Echocardiogra...mentioning

confidence: 99%

Right-Sided Cardiac Thrombosis and Pulmonary Thromboembolism in Chronic Chagas Disease: A Review of Clinical Features and Post-Mortem Examination

Bestetti,

Soares,

Furlan-Daniel

et al. 2024

Rev. Cardiovasc. Med.

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Pulmonary thromboembolism (PE) is a potential major complication in patients with chronic Chagas heart disease (CChD). The source of PE is the right-sided chambers instead of deep vein thrombosis. Little is known regarding risk factors, clinical picture, and the clinical course of patients with PE secondary to CChD. The aim of this review was to try to provide doctors with such data. We searched for papers related to PE in CChD patients in the PUBMED from 1955 to 2020. Twenty-six manuscripts were retrieved, of which 12 fulfilled entry criteria and were included in the study. Right-sided cardiac thrombosis or PE was confirmed on morphological or imaging studies. A total of 431 patients with PE were reported. Age varied from 30 to 85 years. About 332 patients were reported to have chronic heart failure (CHF), whereas 41 (9%) sudden cardiac death (SCD) at autopsy. Clinical manifestations reported were sudden onset dyspnea was found in 1 patient, haemoptysis in 2, worsening CHF in 2, and chest pain in 1. An X-ray chest was reported for 6 patients: abnormalities consistent with PE were found in 3. The resting electrocardiogram (ECG) was reported for 5 patients: it was abnormal in all. One study reported a mean left ventricular ejection fraction of 42.1 18.7%. The prevalence of right-sided cardiac thrombosis varied from 66% to 85% patients. PE was the cause of death in 17% of patients. The clinical diagnosis of PE in patients with Chagas cardiomyopathy (ChCM) is very difficult in the absence of a prediction score that performs well. However, in the presence of haemoptysis or worsening heart failure (HF), abnormal ECG, or chest X-ray, the diagnosis of PE should be raised, and patients promptly referred to detailed Doppler Tissue Echocardiography and computed tomography angiography, and treated in a timely manner.

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“…Detailed echocardiography for each patient was not reported. In one study, the mean left ventricular ejection fraction (LVEF) of all patients with CHF included in the investigation was 42.1

Section: Clinical Radiological Electrocardiographic and Echocardiogra...mentioning

confidence: 99%

Right-Sided Cardiac Thrombosis and Pulmonary Thromboembolism in Chronic Chagas Disease: A Review of Clinical Features and Post-Mortem Examination

Bestetti,

Soares,

Furlan-Daniel

et al. 2024

Rev. Cardiovasc. Med.

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“…Patients with prevalent HF were excluded from this analysis [ 17 ]. An autopsy study of patients who died from HF showed that thromboembolism was a direct cause in 25% of deaths and a contributing cause in another 42% [ 16 ]. The most common type of VTE was PE, which was the cause of 36% of deaths among HF patients [ 16 ].…”

Section: The Relationship Between Cvd and Cardiovascular Diseasementioning

confidence: 99%

Cardiovascular Insights for the Appropriate Management of Chronic Venous Disease: A Narrative Review of Implications for the Use of Venoactive Drugs

Gianesini,

De Luca,

Feodor

et al. 2023

Adv Ther

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Evidence suggests that chronic venous disease (CVD) may be a cardiovascular disorder, as patients with CVD are prone to developing arterial (atherosclerosis) and venous (thromboembolism) diseases. This may be partly explained by shared risk factors. Thus, patients with CVD or cardiovascular disease require careful history-taking and physical assessment to identify coexisting pathologies and risk factors. This article summarises a symposium at the XIX World Congress of the International Union of Phlebology held in Istanbul, Turkey, in September 2022. Common pathophysiological features of CVD and cardiovascular disease are endothelial injury, hypercoagulability and systemic inflammation. In CVD, inflammation primarily affects the microcirculation, with changes in capillary permeability, vein wall and valve remodelling and increase in oxidative stress. Once patients develop symptoms/signs of CVD, they tend to reduce their physical activity, which may contribute to increased risk of cardiovascular disease. Data show that the presence of CVD is associated with an increased risk of cardiovascular disease, including peripheral arterial disease and heart failure (HF), and the risk of adverse cardiovascular events increases with CVD severity. In addition, patients with cardiovascular disease, particularly those with HF, are at increased risk of venous thromboembolism (VTE) and should be assessed for VTE risk if they are hospitalised with cardiovascular disease. Therefore, CVD management must include a multi-specialty approach to assess risk factors associated with both the venous and arterial systems. Ideally, treatment should focus on the resolution of endothelial inflammation to control both CVD and cardiovascular disease. International guidelines recommend various conservative treatments, including venoactive drugs (VADs), to improve the symptoms/signs of CVD. Micronized purified flavonoid fraction (MPFF) is a VAD, with high-quality evidence supporting its use in relieving symptoms/signs of CVD and improving quality of life. Moreover, in large-scale observational studies, MPFF has shown superior effectiveness in real-world populations compared with other VADs. Electronic supplementary material The online version of this article (10.1007/s12325-023-02657-0) contains supplementary material, which is available to authorized users.

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“…Clinically, the diagnosis of Chagas disease is an independent predictor of PE ( 68 ), and right-sided cardiac thrombosis can be detected in about 58% of patients with Chagas disease heart failure ( 69 ). Nevertheless, right-sided cardiac thrombosis can be found in patients with right ventricular dysfunction without overt CHF ( 70 ).…”

Section: Cardiovascular Diseases Managementmentioning

confidence: 99%

Management of Cardiovascular Disease in Patients With COVID-19 and Chronic Chagas Disease: Implications to Prevent a Scourge Still Larger

Bestetti

Bocchi²,

Bestetti³

et al. 2022

Front. Med.

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Cardiovascular diseases (CVD) are the most important cause of morbidity and mortality in the general population. Because the high prevalence of COVID-19 and chronic Chagas disease (CCD) where the latter is endemic, all such diseases will likely be observed in the same patient. While COVID-19 can provoke generalized endotheliitis, which can lead to a cytokine storm and a hyper-coagulable state culminating into in-site and at a distance thrombosis. Therefore, small-vessel coronary artery disease (CAD), cerebrovascular disease, thromboembolism, and arrhythmias are prominent findings in COVID-19. In CCD, small-vessel CAD, cardioembolic stroke, pulmonary embolism, heart failure and arrhythmias are frequently observed as a result of a similar but less intense mechanism. Consequently, the association of CCD and COVID-19 will likely increase the incidence of CVD. Thus, doctors on the frontline should be on the alert for this diagnostic possibility so that the proper treatment can be given without any delay.

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Thromboembolic findings in patients with heart failure at autopsy

Cited by 10 publications

References 21 publications

Right-Sided Cardiac Thrombosis and Pulmonary Thromboembolism in Chronic Chagas Disease: A Review of Clinical Features and Post-Mortem Examination

Right-Sided Cardiac Thrombosis and Pulmonary Thromboembolism in Chronic Chagas Disease: A Review of Clinical Features and Post-Mortem Examination

Cardiovascular Insights for the Appropriate Management of Chronic Venous Disease: A Narrative Review of Implications for the Use of Venoactive Drugs

Management of Cardiovascular Disease in Patients With COVID-19 and Chronic Chagas Disease: Implications to Prevent a Scourge Still Larger

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