Right heart thrombus with pulmonary embolism tied to poor survival, ICU admission

Clinical presentation is more severe and survival much lower among patients with right heart thrombus and pulmonary embolism, who also require more advanced therapies, compared with those without a concomitant pulmonary embolism, a study has found. Thrombus mobility and size contribute to the development of concomitant pulmonary embolism.

“Right heart thrombus in the setting of acute pulmonary embolism represents a unique clinical entity that is associated with worse prognosis compared with right heart thrombus only,” the investigators said.

In this multicentre observational cohort study, patients presenting with right heart thrombus with and without a concurrent pulmonary embolism were included. Ninety-day all-cause mortality served as the primary endpoint. The investigators assessed the outcomes using multivariable regression.

Some 231 patients with right heart thrombus (median age 59.4 years) were assessed, of whom 104 (45.0 percent) presented with a pulmonary embolism upon admission. Pulmonary embolism in the setting of a right heart thrombus contributed to a higher adjusted risk of 90-day mortality (hazard ratio, 3.68, 95 percent confidence interval [CI], 1.51‒8.97).

Patients with right heart thrombus and concomitant pulmonary embolism were also more likely succumb to this condition in the hospital (odds ratio [OR], 2.55, 95 percent CI, 1.15‒5.94) or be admitted to the intensive care unit (OR, 2.45, 95 percent CI, 1.23‒4.94).

Development of concurrent pulmonary embolism was significantly associated with thrombus mobility (OR, 2.99, 95 percent CI, 1.35‒6.78) and larger thrombus sizes (OR, 1.04, 95 percent CI, 1.00‒1.07).

“Right heart thrombus is a rare but serious form of venous thromboembolic disease that may be associated with pulmonary embolism,” the investigators said. “The prognosis of patients with right heart thrombus presenting without a concomitant pulmonary embolism remains ill-defined.”