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European Heart Journal Advance Access published online on February 4, 2005
European Heart Journal, doi:10.1093/eurheartj/ehi130
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European Heart Journal © The European Society of Cardiology 2005; all rights reserved

Clinical research

Prevalence and risk of pulmonary embolism in patients with intracardiac thrombosis: a population-based study of 23 796 consecutive autopsies

Mats Ögren 1*, David Bergqvist 1, Henry Eriksson 2, Bengt Lindblad 3, and Nils H. Sternby 4

1 Department of Vascular Surgery, Uppsala University Hospital, SE-751 85 Uppsala, Sweden
2 Department of Medicine, Sahlgrenska University Hospital/Östra, Göteborg, Sweden
3 Department of Vascular Surgery, Lund University, Malmö University Hospital, Sweden
4 Department of Pathology, Lund University, Malmö University Hospital, Sweden

* To whom correspondence should be addressed.
Mats Ögren, E-mail: mats.ogren{at}astrazeneca.com


  Abstract

Aims While right intracardiac thrombosis (IT) is a potential cause of pulmonary embolism (PE) similar to that of stroke in left-sided IT, its prevalence and prognostic significance has not been studied in the general population. The aim of this study was to assess the age- and gender-specific prevalence of IT and its relation to PE in a population-based autopsy cohort.

Methods and Results Between 1970 and 1982, 23 796 autopsies, representing 84% of all in-hospital deaths in the Malmö city population, were performed, using a standardized procedure. The relationship between IT and PE was evaluated by cohort analyses and nested case-control studies. IT was present in 1706 (7.2%) patients, 727 and 747 of whom had right and left atrial IT, respectively. PE prevalence in patients with isolated left IT, isolated right IT, and combined IT was 28.5, 35.6, and 48.9%, with RR (95% CI) of 1.5 (1.3-1.8), 2.0 (1.6-2.5), and 3.5 (2.7-4.7), respectively, compared with age- and gender-matched controls. Patients dying from ischaemic heart disease had a 3.2 (2.7-3.6) times higher risk of right IT, which was associated with 43% PE prevalence. Of all patients with PE at autopsy, right IT was found in 354 (6.5%), and the only detected source of PE in 220 (4.0%).

Conclusion Right cardiac thrombosis, though difficult to assess clinically, is as common as left cardiac thrombosis and is associated with an increased risk of PE. The diagnosis should be considered in all cases of PE, especially in patients with atrial fibrillation or myocardial infarction and in the absence of confirmed deep vein thrombosis.

Keywords: Venous thromboembolism; Atrial thrombosis; Ventricular thrombosis; Necropsy; Atrial fibrillation complication; Epidemiology.
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