| Intracardiac thrombosis and anticoagulation therapy in cardiac amyloidosis. | |
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MedLine Citation:
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PMID: 19414641 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Primary amyloidosis has a poor prognosis as a result of frequent cardiac involvement. We recently reported a high prevalence of intracardiac thrombus in cardiac amyloid patients at autopsy. However, neither the prevalence nor the effect of anticoagulation on intracardiac thrombus has been evaluated antemortem. METHODS AND RESULTS: We studied all transthoracic and transesophageal echocardiograms of cardiac amyloid patients at the Mayo Clinic. The prevalence of intracardiac thrombosis, clinical and transthoracic/transesophageal echocardiographic risks for intracardiac thrombosis, and effect of anticoagulation were investigated. We identified 156 patients with cardiac amyloidosis who underwent transesophageal echocardiograms. Amyloidosis was the primary type (AL) in 80; other types occurred in 76 patients, including 56 with the wild transthyretin type, 17 with the mutant transthyretin type, and 3 with the secondary type. Fifth-eight intracardiac thrombi were identified in 42 patients (27%). AL amyloid had more frequent intracardiac thrombus than the other types (35% versus 18%; P=0.02), although the AL patients were younger and had less atrial fibrillation. Multivariate analysis showed that atrial fibrillation, poor left ventricular diastolic function, and lower left atrial appendage emptying velocity were independently associated with increased risk for intracardiac thrombosis, whereas anticoagulation was associated with a significantly decreased risk (odds ratio, 0.09; 95% CI, 0.01 to 0.51; P<0.006). CONCLUSIONS: Intracardiac thrombosis occurs frequently in cardiac amyloid patients, especially in the AL type and in those with atrial fibrillation. Risk for thrombosis increased if left ventricular diastolic dysfunction and atrial mechanical dysfunction were present. Anticoagulation therapy appears protective. Timely screening in high-risk patients may allow early detection of intracardiac thrombus. Anticoagulation should be carefully considered. |
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Authors:
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DaLi Feng; Imran S Syed; Matthew Martinez; Jae K Oh; Allan S Jaffe; Martha Grogan; William D Edwards; Morie A Gertz; Kyle W Klarich |
Publication Detail:
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Type: Journal Article Date: 2009-05-04 |
Journal Detail:
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Title: Circulation Volume: 119 ISSN: 1524-4539 ISO Abbreviation: Circulation Publication Date: 2009 May |
Date Detail:
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Created Date: 2009-05-12 Completed Date: 2009-06-09 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0147763 Medline TA: Circulation Country: United States |
Other Details:
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Languages: eng Pagination: 2490-7 Citation Subset: AIM; IM |
Affiliation:
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Metropolitan Heart and Vascular Institute, Minneapolis, Minn, USA. dali.feng@metrocardiology.com |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Age Distribution Aged Aged, 80 and over Amyloidosis / epidemiology* Anticoagulants / therapeutic use* Coronary Thrombosis / drug therapy*, epidemiology*, ultrasonography Echocardiography, Transesophageal Female Heart Failure / epidemiology Humans Male Middle Aged Multivariate Analysis Predictive Value of Tests Prevalence Risk Factors Ventricular Dysfunction, Left / epidemiology |
| Chemical | |
Reg. No./Substance:
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0/Anticoagulants |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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