Thromb Haemost 2014; 111(01): 53-57
DOI: 10.1160/TH13-04-0303
Blood Coagulation, Fibrinolysis and Cellular Haemostasis
Schattauer GmbH

Prognostic significance of free-floating right heart thromboemboli in acute pulmonary embolism

Results from the Italian Pulmonary Embolism Registry
Franco Casazza
1   UO Cardiologia-Ospedale S. Carlo Borromeo, Milano, Italy
,
Cecilia Becattini
2   UO Medicina Interna e Vascolare-Stroke Unit,Università di Perugia, Perugia, Italy
,
Emanuele Guglielmelli
3   Dipartimento di Emergenza-Ospedale S. Camillo Forlanini, Roma, Italy
,
Irene Floriani
4   Istituto di Ricerche Farmacologiche “Mario Negri”, Milano, Italy;
,
Vincenzo Morrone
5   UO Cardiologia-Ospedale S. Annunziata, Taranto, Italy
,
Carla Caponi
6   UO Medicina-Ospedale di Cles (TN), Cles, Italy)
,
Luigi Pizzorno
7   UO Cardiologia- Ospedale Padre Micone, Genova, Italy
,
Luca Masotti
8   UO Medicina-Ospedale di Cecina (LI), Cecina, Italy
,
Amedeo Bongarzoni
1   UO Cardiologia-Ospedale S. Carlo Borromeo, Milano, Italy
,
Luigi Pignataro
1   UO Cardiologia-Ospedale S. Carlo Borromeo, Milano, Italy
› Author Affiliations
Further Information

Publication History

Received: 15 April 2013

Accepted after major revision: 28 August 2013

Publication Date:
21 November 2017 (online)

Summary

The exact prevalence of mobile right heart thromboemboli (RHTh) in patients with pulmonary embolism (PE) is unknown, depending upon PE severity and the use of early echocardiography. Similarly, the mortality rate is variable, though RHTh detection appears to substantially increase the risk of death in patients with PE. The aim of this study was to assess the prevalence of RHTh in different risk categories in a wide series of patients with PE, and to analyse the effect of RHTh on in-hospital mortality. Among 1,716 patients enrolled in the Italian Pulmonary Embolism Registry, 1,275 (13.3% at high risk, 59.3% at intermediate risk and 27.4% at low risk) had echocardiography within 48 hours from hospital admission and entered the study. Overall, RHTh were detected in 57 patients (4.5%, at admission echocardiography in 88%): in 27/169 (16%) high-risk, in 29/756 (3.8%) intermediate-risk and 1/350 (0.3%) low-risk patients, respectively. At multivariate analysis, only advanced age (odds ratio [OR] 1.61, 95% confidence [CI] 1.27–2.03, p<0.0001), high-risk category (OR vs low-risk category 37.82, 95% CI 11.26–127.06, p<0.0001) and recurrent PE (OR 45.92, 95%CI 15.19–139.96, p<0.0001) showed a statistically significant effect on mortality. The presence of RHTh significantly increased the risk of dying (OR 3.89, 95%CI 1.98–7.67, p=0.0001) at univariate analysis, but this result was not mantained in the multivariate model (OR 1.64, 95%CI 0.75–3.60, p=0.216). In conclusion, though patients with RHTh had a more severe presentation of PE, this study did not detect an association between RHTh and prognosis.

 
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