Key result
Right heart thrombus was found in 2% of patients with central pulmonary embolism; among these 9 patients, all had RV dysfunction, 8 received RHT-directed interventions, and 1 died in-hospital.
Why the study?
Right heart thrombus is an uncommon finding in pulmonary embolism associated with increased inpatient mortality, but no consensus exists regarding its management.
Cross-Sectional (n=9)
No
Right heart thrombus is a rare finding (2%) in central pulmonary embolism, typically presenting with RV dysfunction and treated with various RHT-directed therapies alongside anticoagulation.
RHT management varies in central PE; leaves open optimal strategy pending prospective trials.
INTRODUCTION: Right heart thrombus (RHT), also known as clot in transit, is an uncommon finding in pulmonary embolism (PE) that is associated with increased inpatient mortality. To date, there is no consensus on the management of RHT. Therefore, we aim to describe the clinical features, treatments, and outcomes of patients with simultaneous RHT and PE. METHODS: This is a retrospective, cross-sectional, and single-center study of hospitalized patients with central PE who had RHT visualized on transthoracic echocardiography (TTE) from January 2012 to May 2022. We use descriptive statistics to describe their clinical features, treatments, and outcomes, including mechanical ventilation, major bleeding, inpatient mortality, length of hospital stay, and recurrent PE on follow-up. RESULTS: Of 433 patients with central PE who underwent TTE, nine patients (2%) had RHT. The median age was 63 years (range 29-87), most were African American (6/9), and females (5/9). All patients had evidence of RV dysfunction and received therapeutic anticoagulation. Eight patients received RHT-directed interventions, including systemic thrombolysis (2/9), catheter-directed suction embolectomy (4/9), and surgical embolectomy (2/9). Regarding outcomes, 4/9 patients were hemodynamically unstable, 8/9 were hypoxemic, and 2/9 were mechanically ventilated. The median length of hospital stay was six days (range 1-16). One patient died during hospital admission, and two patients had recurrent PE. CONCLUSION: We described the different therapeutic approaches and outcomes of patients with RHT treated in our institution. Our study adds valuable information to the literature, as there is no consensus on the treatment of RHT. HIGHLIGHTS: Right heart thrombus (RHT) was a rare finding in central pulmonary embolism. Most patients with RHT had evidence of RV dysfunction and pulmonary hypertension. Most patients received RHT-directed therapies in addition to therapeutic anticoagulation.
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Cantú-Martínez et al. (2023) conducted a cross-sectional in Central pulmonary embolism and right heart thrombus (n=9). Right heart thrombus (RHT) and RHT-directed interventions was evaluated on Clinical features, treatments, and outcomes including mechanical ventilation, major bleeding, inpatient mortality, length of hospital stay, and recurrent PE. Right heart thrombus was found in 2% of patients with central pulmonary embolism; among these 9 patients, all had RV dysfunction, 8 received RHT-directed interventions, and 1 died in-hospital.
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