title: Intracardiac thrombosis and embolism in patients with cardiac amyloidosis.
abstract: BACKGROUND
  Patients with primary amyloidosis (AL type) have a poor prognosis, in part due to frequent cardiac involvement. Although intracardiac thrombus has been reported in anecdotal cases, neither its frequency nor its role in causing mortality is known. Furthermore, the clinical and echocardiographic variables that may be associated with thromboembolism in cardiac amyloidosis have not been defined.
  
  
  RESULTS
  A total of 116 autopsy or explanted cases of cardiac amyloidosis (55 AL and 61 other type) were identified in the Mayo Clinic. Forty-six fatal nonamyloid trauma cases served as controls. Each heart was examined for intracardiac thrombus. The cause of death was determined from autopsy and clinical notes. Intracardiac thrombosis was identified in 38 hearts (33%). Twenty-three had 1 thrombus, whereas 15 had 2 to 5 thrombi. Although subjects in the AL group were younger and had less atrial fibrillation than those with other types of amyloidosis, the AL group had significantly more intracardiac thrombus (51% versus 16%, P<0.001) and more fatal embolic events (26% versus 8%, P<0.03). Control hearts had no intracardiac thrombus. The presence of both atrial fibrillation and AL was associated with an extremely high risk for thromboembolism (odds ratio 55.0 [95% confidence interval 8.1 to 1131.4]). By multivariate analysis, AL type (odds ratio 8.4 [95% confidence interval 1.8 to 51.2]) and left ventricular diastolic dysfunction (odds ratio 12.2 [95% confidence interval 2.7 to 72.7]) were independently associated with thromboembolism.
  
  
  CONCLUSIONS
  A high frequency of intracardiac thrombosis was present in cardiac amyloidosis. Furthermore, thromboembolism caused significant fatality. Several risk factors for thromboembolism were identified. Early screening, especially in high-risk patients, and early anticoagulation might reduce morbidity and mortality.
authors.affiliation: Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
authors.forename: DaLi
authors.initials: D
authors.lastname: Feng
authors.forename: William D
authors.initials: WD
authors.lastname: Edwards
authors.forename: Jae K
authors.initials: JK
authors.lastname: Oh
authors.forename: Krishnaswamy
authors.initials: K
authors.lastname: Chandrasekaran
authors.forename: Martha
authors.initials: M
authors.lastname: Grogan
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Martinez
authors.forename: Imran S
authors.initials: IS
authors.lastname: Syed
authors.forename: Imran I
authors.initials: II
authors.lastname: Syed
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Hughes
authors.forename: John A
authors.initials: JA
authors.lastname: Lust
authors.forename: Allan S
authors.initials: AS
authors.lastname: Jaffe
authors.forename: Morie A
authors.initials: MA
authors.lastname: Gertz
authors.forename: Kyle W
authors.initials: KW
authors.lastname: Klarich
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000686:Amyloidosis / Q000150:complications / Q000401:mortality / Q000503:physiopathology*; D016208:Databases, Factual; D005260:Female; D006331:Heart Diseases / Q000150:complications / Q000401:mortality / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D013923:Thromboembolism / Q000150:complications / Q000401:mortality / Q000503:physiopathology*