title: Right heart thrombi in pulmonary embolism.
abstract: There is a lack of comprehensive data on the prevalence, predictors and prognostic significance of right heart thrombi (RHT) in pulmonary embolism.In this study of patients with pulmonary embolism from the Registro Informatizado de la Enfermedad TromboEmbólica (RIETE) registry, we assessed the prevalence and predictors of RHT, and the association between the presence of RHT and the outcomes of all-cause mortality, pulmonary embolism-related mortality, recurrences, and major bleeding through 30 days after initiation of pulmonary embolism treatment.Of 12 441 patients with pulmonary embolism and baseline echocardiographic data, 2.6% had RHT. The following increased the risk of RHT: younger age, previous bleeding, congestive heart failure, cancer, syncope, systolic blood pressure <100 mmHg, and arterial oxyhaemoglobin saturation <90%. Patients with RHT were significantly more likely to die from any cause (adjusted OR 2.50 (95% CI 1.62-3.84); p<0.001) and from pulmonary embolism (adjusted OR 4.29 (95% CI 2.45-7.48); p<0.001) during follow-up. RHT was associated with an increased risk of recurrence during follow-up (1.8% versus 0.7%; p=0.04). Major bleeding was similar in patients with and without RHT.In patients presenting with pulmonary embolism, RHT is relatively infrequent. Patients with RHT had a worse outcome when compared with those without RHT.
authors: Respiratory Dept, Ramón y Cajal Hospital and Universidad de Alcala (IRYCIS), Madrid, Spain.|Both authors contributed equally to the manuscript.
authors: Deisy
authors: D
authors: Barrios
authors: Dept of Internal Medicine, Hospital Clinico Universitario Virgen de la Arrixaca, Murcia, Spain.|Both authors contributed equally to the manuscript.
authors: Vladimir
authors: V
authors: Rosa-Salazar
authors: Respiratory Dept, Ramón y Cajal Hospital and Universidad de Alcala (IRYCIS), Madrid, Spain djimenez.hrc@gmail.com.
authors: David
authors: D
authors: Jiménez
authors: Respiratory Dept, Ramón y Cajal Hospital and Universidad de Alcala (IRYCIS), Madrid, Spain.
authors: Raquel
authors: R
authors: Morillo
authors: Respiratory Dept, Ramón y Cajal Hospital and Universidad de Alcala (IRYCIS), Madrid, Spain.
authors: Alfonso
authors: A
authors: Muriel
authors: Dept of Internal Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors: Jorge
authors: J
authors: Del Toro
authors: Dept of Internal Medicine, Hospital Universitario Reina Sofía, Córdoba, Spain.
authors: Luciano
authors: L
authors: López-Jiménez
authors: Dept of Internal Medicine and Pathology, Hôpital Saint-Louis, Paris, France.
authors: Dominique
authors: D
authors: Farge-Bancel
authors: Divisions of Pulmonary and Critical Care Medicine and General Medical Sciences, Washington University School of Medicine, St. Louis, MO, USA.
authors: Roger
authors: R
authors: Yusen
authors: Dept of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Universidad Católica de Murcia, Spain.
authors: Manuel
authors: M
authors: Monreal
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D015897:Comorbidity; D004452:Echocardiography; D005260:Female; D006321:Heart / Q000502:physiology; D006333:Heart Failure; D006470:Hemorrhage; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010108:Oxyhemoglobins / Q000378:metabolism; D015995:Prevalence; D011379:Prognosis; D011655:Pulmonary Embolism / Q000150:complications* / Q000453:epidemiology / Q000401:mortality; D012042:Registries; D012189:Retrospective Studies; D012306:Risk; D013599:Systole; D013927:Thrombosis / Q000150:complications* / Q000453:epidemiology / Q000401:mortality; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D010108:Oxyhemoglobins