Key result
Left atrial thrombus is linked to ~61% higher major cardiovascular events risk compared with matched controls.
Why the study?
The prognostic impact of intracardiac thrombus varies by cardiac chamber, but large-scale comparative long-term outcome data across all four chambers are limited.
Does the presence and specific cardiac chamber location of an intracardiac thrombus alter the long-term risk of adverse cardiovascular outcomes compared to matched controls without thrombus?
Cohort (n=6,553)
Yes
Does the presence and specific cardiac chamber location of an intracardiac thrombus alter the long-term risk of adverse cardiovascular outcomes compared to matched controls without thrombus?
The long-term prognostic impact of intracardiac thrombus is highly dependent on the chamber involved, with left-sided thrombi predicting broad cardiovascular risk and right atrial thrombi predominantly driving pulmonary embolism.
Answers are grounded in this paper and cite their sources.
May inform chamber-specific risk assessment; leaves open whether findings warrant targeted interventions before prospective validation.
Background The prognostic impact of intracardiac thrombus varies by cardiac chamber, yet large-scale comparative long-term outcome data across all four chambers remain limited. Methods In this retrospective propensity-matched cohort study using the Chang Gung Research Database (2001–2022), we identified 1,541 patients in the final propensity-matched analytic cohorts with echocardiographically confirmed single-chamber intracardiac thrombus [left atrial (LA) n = 619, left ventricular (LV) n = 774, right atrial (RA) n = 125, right ventricular (RV) n = 23]. Patients were 1:4 matched with controls without thrombus for demographics, comorbidities, and medications. Primary outcomes included ischemic stroke/systemic embolism, pulmonary embolism, myocardial infarction, heart failure, cardiac death, and major adverse cardiovascular events (MACE; composite of the above). Follow-up continued until the first event, death, or December 31, 2022. Findings Compared with matched controls, LA thrombus was associated with increased risks of ischemic stroke/systemic embolism (hazard ratio, HR = 1.85), heart failure (HR = 1.30), cardiac death (HR = 2.02), and MACE (HR = 1.61). LV thrombus was associated with increased risks of ischemic stroke/systemic embolism (HR = 1.38), myocardial infarction (HR = 1.58), heart failure (HR = 1.40), cardiac death (HR = 1.32), and MACE (HR = 1.36). RA thrombus was associated with pulmonary embolism (HR = 4.63), heart failure (HR = 1.70), and MACE (HR = 1.63), whereas cardiac death was not significantly increased (HR = 1.96). RV thrombus was rare and showed no significant associations with any outcome. Left atrial appendage thrombus did not confer additional risk compared with non-appendage LA thrombus. Conclusions The prognostic impact of intracardiac thrombus is strongly location-dependent. LV and LA thrombi carried the broadest cardiovascular risks, RA thrombus was disproportionately linked to pulmonary embolism and mortality, and RV thrombus had limited long-term impact. These findings support chamber-specific risk stratification and management strategies for patients with echocardiography-detected intracardiac thrombus.
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Wu et al. (2026) conducted a cohort in Intracardiac thrombus (n=6,553). Intracardiac thrombus vs. Propensity-matched controls without thrombus was evaluated on Major adverse cardiovascular events (MACE) in patients with left atrial thrombus (HR 1.61, 95% CI 1.39-1.86, p=<0.0001). Left atrial and left ventricular thrombi increased the risk of major adverse cardiovascular events compared with matched controls, whereas right atrial thrombus was disproportionately linked to pulmonary embolism.
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