CLINICAL RESEARCH: PULMONARY VASCULAR DISORDERS
Right heart thrombi in pulmonary embolism
Results from the international cooperative pulmonary embolism registry
Adam Torbicki, MD*,*,
Nazzareno Galié, MD ,
Anna Covezzoli, BS ,
Elisa Rossi, BS,
Marisa De Rosa, PhD,
Samuel Z. Goldhaber, MD ICOPER Study Group
* Institute of Tuberculosis and Lung Disease, Warsaw, Poland
Institute of Cardiology, University of Bologna, Bologna, Italy
CINECA Interuniversity Consortium, Bologna, Italy
Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
Manuscript received February 7, 2003;
accepted March 7, 2003.
* Reprint requests and correspondence: Dr. Adam Torbicki, Department of Chest Medicine, Institute of Tuberculosis and Lung Diseases, ul Plocka 26, 01-138, Warszawa, Poland.
torbi{at}pol.pl
OBJECTIVES: This study was designed to investigate the prevalence and prognostic significance of right heart thrombi (RHTh) in pulmonary embolism.
BACKGROUND: Most reports about patients with RHTh are small case series. We analyzed data referring to RHTh among 2,454 consecutive pulmonary embolism patients enrolled in the International Cooperative Pulmonary Embolism Registry.
METHODS: Of the 2,454 patients, 1,113 had results available from baseline echocardiography. We compared the 42 patients with RHTh versus 1,071 without RHTh.
RESULTS: Patients with RHTh had shorter duration of symptoms (2.2 ± 2.9 days vs. 4.3 ± 6.0 days, p = 0.013), lower systolic blood pressure (BP) (116.0 ± 28.8 vs. 125.7 ± 25.0 mm Hg, p = 0.008), and more frequent right ventricular hypokinesis (64% vs. 40%, p = 0.002) and congestive heart failure (26% vs. 13%, p = 0.024); but they had similar age (62.9 vs. 62.5 years), arterial oxygen pressure (71.3 ± 26.0 vs. 69.5 ± 30.5 mm Hg), and prevalence of cancer (14% vs. 19%). The overall mortality rate at 14 days and at three months was higher in patients with RHTh (21% vs. 11%, p = 0.032, and 29% vs. 16%, p = 0.036). The difference in early mortality was observed almost entirely within the subgroup of patients treated with heparin alone (23.5% vs. 8%, p = 0.02), despite similar clinical severity at presentation (systolic BP 122.2 ± 24.2 vs. 127.8 ± 24.1 mm Hg, hypotension in 5.9% vs. 3.4% patients).
CONCLUSIONS: Among patients with acute pulmonary embolism, RHTh is usually found in those more hemodynamically compromised but is also a marker of worse prognosis in initially apparently stable patients treated with heparin alone.
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Abbreviations and Acronyms
| | CHF | = congestive heart failure | | COPD | = chronic obstructive pulmonary disease | | HR | = heart rate | | ICOPER | = International Cooperative Pulmonary Embolism Registry | | PE | = pulmonary embolism | | RH | = right heart | | RV | = right ventricle/ventricular | | RHTh | = right heart thrombi |
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