A Prospective Cross-Sectional Cohort Study on Factors Associations With Right Heart Thrombi and Pulmonary Embolism

Floating thrombus of the right heart chambers is an uncommon diagnosis and is systematically associated with pulmonary embolism. The aim of this study is to describe the management and evolution of right intracavitary thrombi (TIC) in pulmonary embolism.

This was a prospective cohort that ran for 76 months from March 5, 2017 to July 31, 2023. Patients diagnosed with pulmonary embolism were included. Two population groups were established according to the presence or absence of right intracavitary thrombus on Doppler echocardiography (intracavitary thrombi+ vs. intracavitary thrombi-) permitted to compare the risks factors. Thromboembolic risk factors, including the patient's background and clinical, paraclinical, therapeutic and evolutionary aspects, were reported. A significance level of p < 0.05 was used for data analysis.

The prevalence of emboli associated with intracavitary thrombi was 2.98%. Arterial hypotension, right ventricular dilatation, and deaths were significantly associated with right chamber thrombi with p = 0.0051 (OR: 4.14; IC 95%: 1.53-11.2); 0.0015 (OR: 4.4; IC 95%: 1.76-10.9); 0.00 (OR: 9.21; IC 95%: 3.69-23.3); 0.0313 (OR: 3.16; IC 95%: 1.10-9.02), respectively. Thrombolysis was performed in 70.58% of patients in the intracavitary thrombi+ group, compared with 11.93% in the intracavitary thrombi- group. The presence of intracavitary thrombi+ was associated with a high mortality rate of 35.29% compared with 9.82% in the intracavitary thrombi- group.

The discovery of a thrombus of the right heart, although rare, is not exceptional. Their management is the subject of controversy between learned societies. Thrombolysis is the only therapeutic option in this context.