Document Detail

Intracardiac thrombosis and anticoagulation therapy in cardiac amyloidosis.
MedLine Citation:
PMID:  19414641     Owner:  NLM     Status:  MEDLINE    
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.
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:
Type:  Journal Article     Date:  2009-05-04
Journal Detail:
Title:  Circulation     Volume:  119     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2009 May 
Date Detail:
Created Date:  2009-05-12     Completed Date:  2009-06-09     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2490-7     Citation Subset:  AIM; IM    
Metropolitan Heart and Vascular Institute, Minneapolis, Minn, USA.
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MeSH Terms
Age Distribution
Aged, 80 and over
Amyloidosis / epidemiology*
Anticoagulants / therapeutic use*
Coronary Thrombosis / drug therapy*,  epidemiology*,  ultrasonography
Echocardiography, Transesophageal
Heart Failure / epidemiology
Middle Aged
Multivariate Analysis
Predictive Value of Tests
Risk Factors
Ventricular Dysfunction, Left / epidemiology
Reg. No./Substance:

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