title: Computed tomography for the detection of free-floating thrombi in the right heart in acute pulmonary embolism.
abstract: OBJECTIVE
  The aim of this study was to assess the prevalence of free-floating thrombi in the right heart (FFT) and the accuracy of computed tomography (CT) for their detection in pulmonary embolism (PE).
  
  
  METHODS
  We studied 340 consecutive patients presenting with PE. All patients underwent CT and echocardiography.
  
  
  RESULTS
  The prevalence of FFT was 3.5% in the global population of PE and 22% in high-risk PE. Dyspnoea, cardiogenic shock, cardiac arrest and tachycardia were more frequently found in patients with FFT (p = 0.04, p < 0.0001, p = 0.0003 and p = 0.01, respectively). Sensitivity and specificity of CT for the detection of FFT were 100% (95% confidence interval: 74%-100%) and 97% (95%-99%), whereas positive and negative predictive values were 57% (34%-78%) and 100% (99%-100%). Among patients with FFT, right ventricular dilation was always detected by CT, whereas no right ventricular dilation was found among patients with a false diagnosis of FFT performed by CT (p < 0.0001).
  
  
  CONCLUSIONS
  Prevalence of FFT is 3.5% and differs according to the clinical presentation. Detection of FFT by CT is feasible and should lead to echocardiography being promptly performed for the confirmation of FFT.
authors.affiliation: Department of Cardiology, Université de Versailles-Saint Quentin (UVSQ), Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de Référence des Maladies Cardiaques Héréditaires, Boulogne, France. nicolas.mansencal@apr.aphp.fr
authors.forename: Nicolas
authors.initials: N
authors.lastname: Mansencal
authors.forename: David
authors.initials: D
authors.lastname: Attias
authors.forename: Vincent
authors.initials: V
authors.lastname: Caille
authors.forename: Julien
authors.initials: J
authors.lastname: Desperramons
authors.forename: Julie
authors.initials: J
authors.lastname: Guiader
authors.forename: Mostafa
authors.initials: M
authors.lastname: El Hajjam
authors.forename: Pascal
authors.initials: P
authors.lastname: Lacombe
authors.forename: Imad
authors.initials: I
authors.lastname: Abi Nasr
authors.forename: François
authors.initials: F
authors.lastname: Jardin
authors.forename: Antoine
authors.initials: A
authors.lastname: Vieillard-Baron
authors.forename: Olivier
authors.initials: O
authors.lastname: Dubourg
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D005602:France / Q000453:epidemiology; D006331:Heart Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013927:Thrombosis / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D055815:Young Adult
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