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Intracardiac Thrombosis and Embolism in Patients With Cardiac Amyloidosis

DALI FENG ; EDWARDS, William D ; GERTZ, Morie A ; KLARICH, Kyle W ; OH, Jae K ; CHANDRASEKARAN, Krishnaswamy ; GROGAN, Martha ; MARTINEZ, Matthew W ; SYED, Imran I ; HUGHES, Deborah A ; LUST, John A ; JAFFE, Allan S

Circulation (New York, N.Y.), 2007-11, Vol.116 (21), p.2420-2426 [Periódico revisado por pares]

Hagerstown, MD: Lippincott Williams & Wilkins

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Título:
Intracardiac Thrombosis and Embolism in Patients With Cardiac Amyloidosis
Autor: DALI FENG ; EDWARDS, William D ; GERTZ, Morie A ; KLARICH, Kyle W ; OH, Jae K ; CHANDRASEKARAN, Krishnaswamy ; GROGAN, Martha ; MARTINEZ, Matthew W ; SYED, Imran I ; HUGHES, Deborah A ; LUST, John A ; JAFFE, Allan S
Assuntos: Adult ; Aged ; Aged, 80 and over ; Amyloidosis - complications ; Amyloidosis - mortality ; Amyloidosis - physiopathology ; Biological and medical sciences ; Blood and lymphatic vessels ; Blood. Blood coagulation. Reticuloendothelial system ; Cardiology. Vascular system ; Databases, Factual ; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous ; Female ; Heart ; Heart Diseases - complications ; Heart Diseases - mortality ; Heart Diseases - physiopathology ; Heart failure, cardiogenic pulmonary edema, cardiac enlargement ; Humans ; Male ; Medical sciences ; Middle Aged ; Pharmacology. Drug treatments ; Registries ; Thromboembolism - complications ; Thromboembolism - mortality ; Thromboembolism - physiopathology
É parte de: Circulation (New York, N.Y.), 2007-11, Vol.116 (21), p.2420-2426
Notas: ObjectType-Article-1
SourceType-Scholarly Journals-1
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Descrição: Patients with primary amyloidosis (AL type) have a poor prognosis, in part due to frequent cardiac involvement. Although intracardiac thrombus has been reported in anecdotal cases, neither its frequency nor its role in causing mortality is known. Furthermore, the clinical and echocardiographic variables that may be associated with thromboembolism in cardiac amyloidosis have not been defined. A total of 116 autopsy or explanted cases of cardiac amyloidosis (55 AL and 61 other type) were identified in the Mayo Clinic. Forty-six fatal nonamyloid trauma cases served as controls. Each heart was examined for intracardiac thrombus. The cause of death was determined from autopsy and clinical notes. Intracardiac thrombosis was identified in 38 hearts (33%). Twenty-three had 1 thrombus, whereas 15 had 2 to 5 thrombi. Although subjects in the AL group were younger and had less atrial fibrillation than those with other types of amyloidosis, the AL group had significantly more intracardiac thrombus (51% versus 16%, P<0.001) and more fatal embolic events (26% versus 8%, P<0.03). Control hearts had no intracardiac thrombus. The presence of both atrial fibrillation and AL was associated with an extremely high risk for thromboembolism (odds ratio 55.0 [95% confidence interval 8.1 to 1131.4]). By multivariate analysis, AL type (odds ratio 8.4 [95% confidence interval 1.8 to 51.2]) and left ventricular diastolic dysfunction (odds ratio 12.2 [95% confidence interval 2.7 to 72.7]) were independently associated with thromboembolism. A high frequency of intracardiac thrombosis was present in cardiac amyloidosis. Furthermore, thromboembolism caused significant fatality. Several risk factors for thromboembolism were identified. Early screening, especially in high-risk patients, and early anticoagulation might reduce morbidity and mortality.
Editor: Hagerstown, MD: Lippincott Williams & Wilkins
Idioma: Inglês

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Intracardiac Thrombosis and Embolism in Patients With Cardiac Amyloidosis

DALI FENG ; EDWARDS, William D ; GERTZ, Morie A ; KLARICH, Kyle W ; OH, Jae K ; CHANDRASEKARAN, Krishnaswamy ; GROGAN, Martha ; MARTINEZ, Matthew W ; SYED, Imran I ; HUGHES, Deborah A ; LUST, John A ; JAFFE, Allan S

Hagerstown, MD: Lippincott Williams & Wilkins

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