Clinical Characteristics And Prognosis Of Patients With Intracardiac Thrombosis Caused By Non-coronary Artery Diseases

[Background]Intracardiac thrombosis is a complication of various heart diseases and systemic diseases.With the wide application of percutaneous coronary intervention.the incidence of intracardiac thrombosis after acute coronary syndrome caused by coronary heart disease has decreased significantly,while other diseases combined with intracardiac thrombosis have been paid more attention.[Objective]To study the clinical characteristics and prognosis of patients with intracardiac thrombosis caused by non-coronary heart disease.[Methods]Retrospect the hospitalized patients who met the diagnosis of "intracardiac thrombosis" in Peking Union Medical College Hospital from January 1,2013 to December 31,2020,excluding patients with intracardiac thrombosis caused by coronary heart disease or ischemic cardiomyopathy.The general data,clinical manifestation,laboratory examination,imaging tests,treatment and prognosis of the patients were recorded.At the same time,patients who met the diagnosis of ’Behcet’s disease’ and completed echocardiography were collected and divided into two groups according to whether there was intracardiac thrombosis.The risk factors of intracardiac thrombosis in Behcet’s disease and the prognosis of the two groups were analyzed.The main outcome included all-cause death and thromboembolism.The outcome of intracardiac thrombosis was divided into complete disappearance,partial disappearance and recurrence.Follow-up information was obtained by reviewing the patient ’s regular outpatient records,readmission medical records and telephone follow-up.[Results]A total of 79 patients with intracardiac thrombosis were collected,including cardiomyopathy(42 patients),connective tissue disease(32 patients),valvular disease(3 patients)and malignant tumor(2 patients).Among the 42 patients with cardiomyopathy.33(79%)had thrombus in the left ventricle.Of the 40 patients with cardiomyopathy who received anticoagulant therapy,cardiac thrombus disappeared in 25(60%)patients after a median follow-up of 5(2.10.5)months.Among the 32 patients with connective tissue disease,13(41%)had thrombus in the right ventricle.Among the 22 patients with connective tissue disease who received anticoagulant therapy,13(59%)had thrombus disappearance after reexamination,and the median time of thrombus disappearance was 6(3,10.5)months.It was found that arterial involvement is an independent risk factor of Behcet’s disease with intracardiac thrombosis(OR 3.150 95%CI 1.040-9.450,P=0.045).The risk of all-cause death and peripheral thromboembolism in patients with Behcet ’s disease with intracardiac thrombosis was significantly higher than the patient without intracardiac thrombosis(HR 15.696 95%CI 3.838-64.183,P<0.001).[Conclusion]The common intracardiac thrombosis sites of different causes are different.Left ventricular thrombus is more common in patients with cardiomyopathy,while right ventricular thrombus is the mainly found in patients with Behcet ’s disease or Systemic lupus erythematosus.Patients with Behcet ’s disease with arterial involvement should be paid more attention to the presence of intracardiac thrombus.In terms of prognosis,the risk of all-cause death and peripheral thromboembolism in patients with Behcet’s disease with intracardiac thrombosis was significantly higher than those without intracardiac thrombosis.Regardless of the cause of intracardiac thrombosis,anticoagulant therapy should be started as soon as possible once thrombus is discovered.