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Right cardiac thrombus tied to mortality with pulmonary thromboemboli

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – In patients with pulmonary thromboemboli, the presence of a mobile right cardiac thrombus (MRCT) is strongly linked to death, new research shows.

Although MRCT is an uncommon finding in patients with pulmonary thromboemboli, it is probably underdiagnosed, Dr. Reza Mollazadeh of Nemazee Hospital, Shiraz, Iran, note. The prognostic significance of this finding has been unclear, they add.

To investigate, Dr. Mollazadeh’s group analyzed data from 12 pulmonary thromboembolism patients with MRCT and 88 without MRCT who were seen at three academic hospitals from January 2004 to November 2006. The presence of a wormlike elongated mass on echocardiography was considered indicative of MRCT.

In terms of symptoms, 11 of the 12 MRCT patients had dyspnea, but only 2 had syncope during exertion, the report in the June issue of Clinical Cardiology indicates.

T inversion was the most common ECG finding in the MRCT group, noted in 9 (75%) patients. This finding was seen in 34 patients in the non-MRCT group (38.6%, p = 0.02).

Troponin I positivity was more common in the MRCT group than in the non-MRCT group (66.6% vs. 9.09%, p = 0.03). On transthoracic echocardiography, MRCT patients had a higher systolic pulmonary artery pressure (67.6 vs. 49.1 mmHg, p = 0.05) and were more likely to have right ventricle free-wall hypokinesia (91.6% vs. 22.7%, p < 0.0001).

Six of the 12 MRCT patients had in-hospital cardiac arrest and all of them died. By contrast, 12 non-MRCT patients had an arrest, but 4 survived. Thus, the hospital mortality rate in MRCT patients was 50% versus 9% in the non-MRCT group.

“The clinical suspicion of pulmonary thromboembolism associated with an image of MRCT is sufficient to initiate early treatment of high-risk patients without further investigation,” the authors conclude. However, the best therapy for pulmonary thromboembolism patients with MRCT remains unclear.

Clin Cardiol 2009;32:E27-E31.