Outcome of Patients with Right Heart Thrombi: The Right Heart Thrombi European Registry
In a study that included case reports from 17 different hospitals in 8 European countries, patients with blood clots in the vessels in the right heart, known as Right Heart Thrombi (RiHT) and Pulmonary embolism were evaluated for therapeutic interventions and prognostic factors. Patient information was prospectively collected using echocardiographic examinations and uploaded to an internet-based registry known as the Right Heart Thrombi European Registry. The study also included a control group for non-RiHT patients with Pulmonary embolism. In total, there were 138 (69 females) eligible for assessment, and the objective was to examine the already confirmed prognostic criteria for 30-day morbidity which include: haemodynamic instability (atypical or unstable blood pressure), right ventricular dysfunction (RVD), simplified Pulmonary Embolism Severity Index (sPESI) score, and laboratory markers of myocardial injury and overload. The researchers looked at the influence of RiHT characteristics on treatment selection and patient outcomes compared to the control group of non-RiHT patients. Those participating were then divided into groups based on their prognostic factors, including both size and mobility of the clot. Patients were divided into high, intermediate, and low risk groups. Specifically, those in the high-risk group were diagnosed as haemodynamically unstable.
Results confirmed that the presence of Right Heart Thrombi in patients with Pulmonary embolism predicted a poor outcome prognosis, and resulted in even worse outcomes with the presence of right ventricular dysfunction. Furthermore, the study also found evidence to suggest that the poor prognosis is more so related to the patient’s haemodynamic instability as a result of PE as opposed to the RiHT itself. As such, RiHT (especially mobile thrombi) are still considered an important factor in prognosis, but it is the complications associated with abnormal blood flow that most strongly predicted patient mortality.