Clinical Characteristics of Patients with a Right Ventricular Thrombus in Arrhythmogenic Right Ventricular Cardiomyopathy

Deniz Akdis; Kai Chen; Ardan M. Saguner; Simon F. Stämpfli; Xiao Chen; Liang Chen; Man Rao; Laurent M. Haegeli; Felix C. Tanner; Corinna Brunckhorst; Jiangping Song; Firat Duru

doi:10.1055/s-0039-1688829

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2019; 119(08): 1373-1378
DOI: 10.1055/s-0039-1688829

Stroke, Systemic or Venous Thromboembolism

Georg Thieme Verlag KG Stuttgart · New York

Clinical Characteristics of Patients with a Right Ventricular Thrombus in Arrhythmogenic Right Ventricular Cardiomyopathy

Authors

Deniz Akdis^*

¹University Heart Center Zurich, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
Kai Chen^*

²Fuwai Hospital, Peking Union Medical College, State Key Laboratory of Cardiovascular Disease, Beijing, China
Ardan M. Saguner

¹University Heart Center Zurich, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
Simon F. Stämpfli

¹University Heart Center Zurich, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
Xiao Chen

²Fuwai Hospital, Peking Union Medical College, State Key Laboratory of Cardiovascular Disease, Beijing, China
Liang Chen

²Fuwai Hospital, Peking Union Medical College, State Key Laboratory of Cardiovascular Disease, Beijing, China
Man Rao

²Fuwai Hospital, Peking Union Medical College, State Key Laboratory of Cardiovascular Disease, Beijing, China
Laurent M. Haegeli

¹University Heart Center Zurich, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
Felix C. Tanner

¹University Heart Center Zurich, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
Corinna Brunckhorst

¹University Heart Center Zurich, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
Jiangping Song^*

²Fuwai Hospital, Peking Union Medical College, State Key Laboratory of Cardiovascular Disease, Beijing, China
Firat Duru^*

¹University Heart Center Zurich, University Hospital of Zurich, University of Zurich, Zurich, Switzerland

³Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland

Abstract

Background Thrombus formation within the left ventricle (LV) is a well-known clinical entity and is often associated with underlying myocardial disease, whereas right ventricular (RV) thrombi are rarely observed. This study aimed to investigate the clinical characteristics of patients with arrhythmogenic RV cardiomyopathy (ARVC) who developed an RV thrombus.

Methods and Results This study included patients with an RV thrombus from the ARVC databases of the University Heart Center in Zurich, Switzerland, and the Fuwai Hospital in Beijing, China. In total, there were 13 ARVC patients who had an RV thrombus detected. The mean age was 33 ± 15 (range: 11–51) years. Eight patients (62%) were male. The mean Task Force score was 6 ± 1. Nine of these patients (69%) had an RV thrombus only whereas four patients had biventricular thrombi. All 13 ARVC patients had a severely impaired RV function (RV fractional area change 16 ± 9% and RV ejection fraction 15 ± 4%); LV ejection fraction (LVEF) was 40 ± 15%. ARVC patients with an additional LV thrombus had a lower LVEF than the others (24 ± 11 vs. 47 ± 11, p = 0.02). Under therapeutic anticoagulation, complete thrombus resolution was observed in 9/13 patients (69%).

Conclusion RV thrombus formation is a potential complication of ARVC with impaired RV function. In patients with biventricular involvement, thrombi may also occur within the LV. Anticoagulation is generally effective to dissolve RV thrombi. This study highlights the need for awareness during cardiac imaging to detect this rare complication of ARVC.

Keywords

right ventricle - thrombus - arrhythmogenic - cardiomyopathy - anticoagulation - imaging

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References

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