Thrombus Group Research Articles

Blood coagulation abnormalities and the usefulness of D-dimer level for detecting intracardiac thrombosis in adult Fontan patients

BackgroundCoagulation abnormality is associated with a high incidence of intracardiac thrombus (ICT) and systemic thromboembolism in Fontan patients. The biomarker for detecting ICT is currently unknown. MethodsWe retrospectively investigated the underlying coagulation abnormality and useful biomarkers to screen for ICT in adult Fontan patients. We measured various biomarkers of blood coagulation, fibrinolysis, and platelet activity in 122 Fontan patients (Fontan group: median age [P25–P75]: 27 [20–34] years) and compared them to those in 50 patients with atrial septal defect (ASD group: 31 [24–40] years). ResultsRegardless of whether the patient had ICT, the Fontan group showed significantly lower levels of antithrombin III, thrombomodulin, and α2-antiplasmin; lower protein C and protein S activities; and significantly higher levels of thrombin-antithrombin complex and α2-plasmin inhibitor complex than the ASD group. Among various biomarkers, D-dimer level measured by using latex immunoassay was significantly higher in the patients with ICT (thrombus group: n=21) than in the patients without ICT (non-thrombus group: n=101). Fifteen (26%) of 57 patients on warfarin achieved prothrombin time international normalized ratios (PT-INRs) of >2. The proportion of patients with PT-INRs of >2 tended to be lower in the thrombus group than in the non-thrombus group (13% vs 31%). Persistent atrial arrhythmia and D-dimer level were significant risk factors associated with ICT formation in the multivariate analysis (persistent atrial arrhythmia: hazard ratio [HR], 6.89; 95% confidence interval [CI], 1.44–34.5; D-dimer: HR, 0.29; 95% CI, 0.13–0.50). Receiver-operating characteristic curve analysis revealed that the appropriate cutoff D-dimer level for screening for ICT was 1.8μg/mL (area under the curve, 0.94), with a negative predictive value of 95%. ConclusionsIn the adult Fontan patients, blood coagulation abnormalities existed regardless of the absence of ICT. D-dimer level may be a useful biomarker for screening for ICT in adult Fontan patients.

Stimulatory effect of an algal fucoidan on the release of vascular endothelial tissue-type plasminogen activator as a mechanism of fucoidan-mediated thrombolysis.

Identifying a pharmacological means for increasing the production of tissue-type plasminogen activator (t-PA) is always desirable to cure impaired production of this enzyme. An algal fucoidan has been shown to exhibit both novel thrombolytic and synergistic stimulatory effects in a mouse thrombosis model. The plasma levels of active t-PA were measured in mouse arterial thrombus models that were treated with various fucoidans to investigate the mechanism of thrombolysis. The mean plasma level of active t-PA after the infusion of fucoidan was 2.136 ± 0.231 ng/ml for nonthrombolytic Fucus fucoidan and 3.917 ± 0.0.529 ng/ml for thrombolytic Undaria fucoidan, which resulted in a 1.56-2.29-fold increase compared with the healthy control group (1.706 ± 0.194 ng/ml) and the untreated thrombus group (2.506 ± 0.301 ng/ml) (P < 0.01). An algal fucoidan has demonstrated to exert a thrombolytic and stimulatory effect via the induction of t-PA release in a dose-dependent manner in an arterial thrombosis model.

Prothrombotic State in Patients With a Left Atrial Appendage Thrombus of Unknown Origin and Cerebrovascular Events.

We hypothesized that formation of left atrial appendage (LAA) thrombi of unknown origin is associated with altered fibrin clot properties and blood hypercoagulability. In a case-control study, we investigated 32 patients with a history of LAA thrombus after successful anticoagulant treatment versus 32 control subjects matched for age, sex, and diabetes mellitus. All subjects had previous ischemic stroke, transient ischemic attack, or migraine associated with patent foramen ovale. Patients with documented atrial fibrillation were excluded. We determined plasma fibrin clot permeability, fibrinolytic efficiency, thrombin generation, platelet and endothelial markers. Stroke or transient ischemic attack were assessed during a median follow-up of 74 (range 19-98) months. Compared with controls, patients with LAA thrombus more frequently were smokers (43.8% versus 18.8%) and had 20% prolonged clot lysis time, lower plasminogen (-14%), and higher plasminogen activator inhibitor-1 (+17%), thrombin-antithrombin complexes (+17%), CD40 ligand (+30%), P-selectin (+29%), and von Willebrand factor (+30%, all P<0.05). Occurrence of LAA thrombus was predicted by von Willebrand factor (β=0.038, P=0.004), plasminogen (β=-0.048, P=0.01), plasminogen activator inhibitor-1 (β=-0.161, P=0.03), and clot permeability (β=-1.076, P=0.03). During follow-up, cerebrovascular events occurred in 10 (33.33%) of the 30 available patients in the LAA thrombus group, including 7 (23.3%) with recurrent LAA thrombus and 4 (13.33%) with documented atrial fibrillation. Recurrent LAA thrombus was associated with lower baseline Ks and higher thrombin generation, fibrinogen, plasminogen activator inhibitor-1, and soluble CD40 ligand (all P<0.05). Prothrombotic blood alterations could be involved in the LAA thrombus formation in patients without documented atrial fibrillation and are associated with increased risk of stroke or transient ischemic attack during follow-up.

Clinical research of detection of thrombosis in patients with lung cancer by protein fingerprinting

Objective To investigate the changes of serum protein fingerprint in patients with lung cancer with deep venous thrombosis. Methods Eighteen case patients with lung cancer were selected, including 8 case of lung cancers with thrombosis and 10 cases of lung cancers with no thrombosis.Surface enhanced laser desorption ionization protein-time of flight mass spectrometry(SELDI-TOF-MS) was used to analyze serum protein content of two groups in the same mass to charge ratios(M/Z), then drew the protein peaks that content difference was statistically significant. Results The M/Z of lung cancer with thrombus group and control group were 5911, 1216, 4187, 1019, 4293, the protein peaks had significant differences between the two group(43.81±7.74, 6.37±5.02, 2.97±0.35, 35.96±12.10, 9.65±4.37; 15.35±12.69, 2.06±0.37, 4.67±1.35, 15.94±6.47, 14.65±8.80; t=5.334, 4.800, 2.981, 4.639, 4.596; P<0.05). Compared with the control group, the decrease of protein peak M/Z were 5911, 1019, 1216, and the increase of protein peak M/Z were 4293, 4187 in the deep venous thrombosis group. Conclusion In the serum of patients with tumors SELDI profiles M/Z are 5911, 4293, 4187, 1019, 1216 of SELDI protein fingerprinting can be considered in patients with thrombosis of tumor specific markers. Key words: Deep venous thrombosis; Lung cancer; Protein fingerprint

Value of R2(*) in evaluating the biological behavior of primary hepatocellular carcinoma

To investigate the correlation between R2(*) value of enhanced T2 star-weighted angiography (ESWAN) sequence and primary hepatocellular carcinoma infiltration and tumor thrombus, and investigate the biological behavior of HCC. A total of 221 cases of patients' imaging data with MRI examination(including ESWAN sequence) diagnosed as primary HCC were retrospectively analyzed.All the patients were collected from January 2014 to September 2015 in the First Affiliated Hospital of Dalian Medical University.The differences of R2(*) values in different MR types of HCC were analyzed.All patients were divided into infiltration group and non-infiltration group, tumor thrombus group and non-tumor thrombus group, the R2(*) values of the paired groups were compared.The diagnostic efficiency of R2(*) in HCC infiltration and tumor thrombus were evaluated by ROC curve, and to find out the threshold values. The MR types of 221 patients included 90 cases of nodular type, 62 cases of massive type, 69 cases of diffuse type.70 patients had tumor thrombus.The R2(*) values of different MR types were (21.82±8.52), (24.17±8.84)and (34.45±11.73) Hz, respectively.There was no statistically significant difference between the nodular and the massive types (P=0.144), while the difference between the nodular and diffuse type, the massive and diffuse types were statistically significant(P=0.000). The R2(*) values of infiltration group and non-infiltration group were (34.45±11.73) and (22.78±8.70) Hz , the R2(*) values of tumor thrombus group and non-tumor thrombus group were (31.20±12.17) and (24.21±9.90) Hz, the difference also had statistically significant(t=7.397 and 4.534, P=0.000 and 0.000). The AUC of R2(*) values for infiltration and tumor thrombus were 0.804, 0.681. R2(*) ≥24.68 Hz was the threshold value to diagnose the infiltration and tumor thrombus. R2(*) value can be used as a MR non-enhancement quantitative index to evaluate the biological behavior of HCC.

MP03-16 RENAL CANCER WITH VENOUS THROMBUS - HOW DIFFERENT RENAL VEIN AND INFERIOR VENA CAVA INVOLVEMENT REALLY ARE?

You have accessJournal of UrologyKidney Cancer: Advanced (including Drug Therapy) I1 Apr 2016MP03-16 RENAL CANCER WITH VENOUS THROMBUS - HOW DIFFERENT RENAL VEIN AND INFERIOR VENA CAVA INVOLVEMENT REALLY ARE? Rodrigo Freddi, Rubens Park, Mauricio Cordeiro, Luiz Oliveira, Giuliano Guglielmetti, Rafael Coelho, Wellington Andraus, and William Nahas Rodrigo FreddiRodrigo Freddi More articles by this author , Rubens ParkRubens Park More articles by this author , Mauricio CordeiroMauricio Cordeiro More articles by this author , Luiz OliveiraLuiz Oliveira More articles by this author , Giuliano GuglielmettiGiuliano Guglielmetti More articles by this author , Rafael CoelhoRafael Coelho More articles by this author , Wellington AndrausWellington Andraus More articles by this author , and William NahasWilliam Nahas More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1909AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES During a long time the patients with tumoral thrombus in renal vein and in the inferior vena cava were staged at the same group in the TNM classification (T3b). Only in the 2009 revision of the TNM system they were separated in 2 different groups - T3a for renal vein involvement and T3b for inferior vena cava involvement, Our intent is to ratify the difference between these 2 groups and to analyze factors that could interfere in the mortality of these patients. METHODS Between 2004 and 2014, 1163 nephrectomys for renal cancer were performed in our service. Reviewing the records of these patients, we identified 64 patients with tumor thrombectomy - 34 with renal vein thrombus and 30 with inferior vena cava thrombus. We compared these 2 groups and analyzed some clinical and pathological factors that could interfere in the prognosis of those patients. RESULTS In the renal vein thrombus group the mean follow-up was 41 months and the median survival was 42,5 months. In the inferior vena cava group the mean follow-up was 24 months and the median survival was 18 months. The difference in median mortality was statiscally significant (p 0,0003) Patients with inferior vena cava thrombus had a mortality rate 3.5 times higher than the patients with renal vein thrombus. In the same analysis, presence of metastasis, lymph node involvement, perirenal fat invasion, Fuhrman stage and histological subtype were not associated with higher mortality rates. CONCLUSIONS The five-year survival is very higher in the patients with renal vein thrombus when compared with then patients with inferior vena cava thrombus, confirming the need to keep these 2 groups in different classifications in the TNM system. There was no other factors impacting in the survival rate of these patients, not even the presence of metastasis at the diagnosis. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e25 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Rodrigo Freddi More articles by this author Rubens Park More articles by this author Mauricio Cordeiro More articles by this author Luiz Oliveira More articles by this author Giuliano Guglielmetti More articles by this author Rafael Coelho More articles by this author Wellington Andraus More articles by this author William Nahas More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Incidence and Morphological Predictors of Intrastent Coronary Thrombus After Drug-Eluting Stent Implantation (from a Multicenter Registry)

The mechanisms responsible for late and very late stent thrombosis remain incompletely understood. This study aimed to evaluate the incidence and morphologic predictors of intrastent thrombus in patients after drug-eluting stent (DES) implantation using optical coherence tomography (OCT). A total of 208 patients with 262 DES who underwent follow-up OCT examination >6 months after DES implantation were included. The detailed vascular morphology including characteristics of neointima was analyzed. Thrombus was identified in 24 patients (11.5%) 11 months after DES implantation. Minimal lumen cross-sectional area was significantly smaller in the thrombus group than in the nonthrombus group (2.9 ± 1.7 vs 4.6 ± 2.0 mm(2); p <0.001). No difference was found in the frequency of uncovered or malapposed struts between the 2 groups. Thin-cap fibroatheroma (20.6% vs 0.1%; p <0.001) and heterogeneous neointima (22.2% vs 9.0%; p = 0.001) were more frequently detected in the thrombus group compared to the nonthrombus group. Second-generation DES showed lower incidence of thrombus, uncovered struts, and extrastent lumen compared with first-generation DES. In conclusion, the present OCT study revealed that smaller lumen cross-sectional area and neointimal morphology are important factors associated with intrastent thrombus. Second-generation DES demonstrated improved arterial healing and a lower incidence of intrastent thrombus compared with first-generation DES.

Relationship between the presence of left atrial thrombus in patients with mitral stenosis and platelet-to-lymphocyte ratio.

Objective:Rheumatic carditis-induced mitral valve disease is associated with a chronic inflammatory process. The close relationship between inflammation and prothrombotic processes is known. Our goal was to examine the relationship between the presence of left atrial (LA) thrombus in patients with rheumatic mitral valve stenosis (RMVS) and platelet-to-lymphocyte ratio (PLR), which is an inflammatory marker.Methods:This cross-sectional study included 351 consecutive patients diagnosed with RMVS upon presentation to the cardiology polyclinic. All patients were evaluated using transthoracic and transesophageal echocardiography and were divided into 2 groups: those with and without LA thrombus. In addition to echocardiographic and biochemical parameters, PLR was compared between the groups. Student’s t-test, Mann–Whitney U test, logistic regression analysis, and receiver operating characteristic (ROC) curve analysis were used for statistical analysis.Results:No significant differences in terms of age, gender, body mass index, and comorbidities were found between the groups with and without LA thrombus. In the group with LA thrombus, higher red cell distribution width, mean platelet volume, and platelet count and lower lymphocyte count were detected. In addition, C-reactive protein levels were significantly higher in the LA thrombus group (4.7 vs. 2.7 mg/L, p<0.001). PLR was significantly higher in patients with thrombus than in those without (133±38 vs. 119±31, p=0.001). Higher PLR was identified as independently associated with the presence of LA thrombus (odds ratio: 1.03, 95% confidence interval: 1–1.06, p=0.016).Conclusion:Higher PLR was detected in the LA thrombus group of patients with RMVS.

Abstract 12030: The Process of Left Atrial Appendage Dysfunction Evaluated by 3D Transesophageal Echocardiography

Introduction: Left atrial appendage (LAA) dysfunction progressively evolves in atrial fibrillation (AF) patients. LAA transesophageal echocardiographic (TEE) parameters can predict thrombotic tendencies and AF treatment outcomes. However, the process of LAA dysfunction remains to be elucidated. Methods: Eighty-four persistent AF patients (64men, age 68±10) that underwent TEE were enrolled. We obtained three-dimensional full-volume LAA data from these patients and reconstructed two-dimensional LAA cross sectional images at the orifice and mid-portion level of the LAA. The maximum and minimum cross-sectional LAA areas were measured at each position and the area change ratio at the orifice (ACR-O) and mid-portion (ACR-M) were calculated. We defined low contractility as a decreasing area change ratio (ACR) of &lt;30% at each position and evaluated the associations between the ACR-O, ACR-M, and continuous AF duration. Results: The patients were categorized into three groups based on the ACR-O and ACR-M: those that maintained both ACR-Os and ACR-Ms (n=48, Group 1), those with reduced ACR-Os and maintained ACR-Ms (n=17, Group 2), and those with both reduced ACR-Os and ACR-Ms (n=19, Group 3). There were no patients with maintained ACR-Os and reduced ACR-Ms. The mean continuous AF durations of each group were 29±42, 54±40, and 88±87 months, respectively. In Group 3, the LAA emptying flow velocity was significantly decreased compared to that in Group 1 and Group 2 (38±19, 31±14, 22±11,cm/s) and LAA thrombi were detected more frequently (0%, 12%, 58%). Conclusions: This study suggested that LAA dysfunction occurred from the orifice and progressed toward the mid-portion. When LAA dysfunction extended over the mid-portion, the LAA flow velocity decreased and LAA thrombi were detected more frequently. Even though anticoagulant drugs were administrated in all patients, 58% of patients had thrombi in Group 3. These patients should be considered for additional therapeutic approaches.

Abstract 11522: Does Neointimal Pattern Predict Instent Thrombus

Introduction: Local determinants of instent thrombus formation after drug-eluting stent (DES) implantation have not been systematically investigated. Hypothesis: Certain neointimal patterns assessed by optical coherence tomography (OCT) may represent local surface thrombogenesity after DES implantation. Methods: A total of 208 patients with 262 DES who underwent follow-up OCT examination 11 months after DES implantation were studied. The detailed OCT findings including characteristics of neointima, lumen size, and stent morphology were compared between the group with and without thrombus. Results: Thrombus was identified in 11.5% (24/208) of the patients. Lipid-laden neointima, thin-cap fibroatheroma, heterogeneous neointima, and extra-stent lumen were more frequently detected in the thrombus group compared to the non-thrombus group (Figure). No difference was found in the % of uncovered (4.9±6.7% vs. 4.2±5.4%; p=0.575) or malapposed struts (1.5±2.5% vs. 0.8±2.1%; p=0.116) between the two groups. Minimal lumen cross sectional area was significantly smaller in the thrombus group compared with the non-thrombus group (2.9±1.7mm 2 vs. 4.6±2.0mm 2 ; p&lt;0.001). Conclusions: Neointimal morphology and smaller lumen cross-section area are important factors associated with instent thrombus.

Incidencia y evolución del trombo intraprótesis tras reparación endovascular de aneurismas aortoilíacos infrarrenales

IntroductionAlthough the appearance of intraprosthetic thrombus after endovascular infrarenal aortoiliac aneurysms repair is common, its clinical impact is not well defined. ObjectiveEndoprosthetic thrombus prevalence, clinical impact and possible related factors. Material and methodsA retrospective review was conducted on 184 Endurant type II stent grafts implanted between Feb/09 and Jun/14. Patients with a follow up less than 5 months were excluded. A record was made of cardiovascular risk factors, treatment, anatomy of aneurysms, endoprosthesis features, prosthetic thrombus appearance and behaviour, endoleaks, ischaemic events, and re-interventions. ResultsThe mean follow up was 20.87 months. Intraprosthetic thrombus was observed in 81 patients (44%). Related factors: active cancer (P=.003; OR 3.639; 95% CI; 1.501-8.825), anticoagulation therapy (P=.006; OR 0.257; 95% CI; 0,092-0,715) and type II endoleaks (P=.013; OR 0.406; 95% CI; 0.197-0.836). The thrombus disappeared in 6 patients during follow up (7%). The thrombus group did not have a higher complication or re-intervention rate when compared with the non-thrombus group. ConclusionIntraprosthetic thrombus occurs frequently. Its clinical behaviour seems benign. Risk factors: Active cancer. Protective factors: Anticoagulation therapy and type II endoleaks.

Ultrasound molecular detection of immediately blood-mediated inflammatory reaction induced by islets transplantation in vitro

To study the feasibility of ultrasonic molecular imaging of immediately blood-mediated inflammatory reaction (IBMIR) in vitro. IBMIR models in vitro were divided into 3 groups: Group A, no microbubbles were added; Group B, non-targeted micro-bubbles were added; Group C, Lys-Gly-Asp-Ser (KGDS)-targeted microbubbles (MBK) were added. The ultrasonic enhancement of IBMIR in loops by ultrasonic contrast imaging was evaluated. The contrast-enhanced US imaging did not show thrombus formation in the group A, whereas the thrombus was found in the Group B and C with a change in filling defects or ring enhancement, respectively. The time for detecting thrombosis was (7.3 ± 0.5) min and (13.2 ± 0.6) min in Group B and Group C, respectively (P<0.05). The average-gray scales of thrombus in Group B and Group C were 31.22 ± 3.56 and 75.85 ± 5.21, respectively (P<0.05). The fluorescence microscope also showed that MBK was attached to thrombus surrounding islets. IBMIR model in vitro showed that KGDS-targeted ultrasound contrast agent could adhere to thrombus shell surrounding islets and molecular target ultrasonography could image these thrombi noninvasively and effectively.

Analysis of Risk Factors for Lower-limb Deep Venous Thrombosis in Old Patients after Knee Arthroplasty.

Background:Deep venous thrombosis (DVT) is a common complication of arthroplasty in old patients. We analyzed risk factors for lower-limb DVT after arthroplasty in patients aged over 70 years to determine controllable risk factors.Methods:This was a retrospective study of 1,025 patients aged >70 years treated with knee arthroplasty at our hospital between January 2009 and December 2013. Of 1,025 patients, 175 had postoperative lower-limb DVT. We compared medical history, body mass index (BMI), ambulatory blood pressure, preoperative and postoperative fasting blood glucose (FBG), preoperative blood total cholesterol, triglyceride, high- and low-density lipoprotein cholesterol, and preoperative homocysteine (Hcy) between thrombus and non-thrombus groups. B-mode ultrasonography was used to detect lower-limb DVT before the operation and 7 days after the operation in all patients. Logistic regression analysis was used to determine risk factors for DVT.Results:Incidence of diabetes (P = 0.014), BMI (P = 0.003), preoperative FBG (P = 0.004), postoperative FBG (P = 0.012), and preoperative Hcy (P < 0.001) were significantly higher in the thrombus group. A significantly greater proportion of patients in the non-thrombus group had early postoperative activity (P < 0.001) and used a foot pump (P < 0.001). Operative duration was significantly longer in the thrombus group (P = 0.012). Within the thrombus group, significantly more patients had bilateral than unilateral knee arthroplasty (P < 0.01). Multivariate logistic analysis revealed BMI, preoperative Hcy, postoperative FBG, long operative duration, bilateral knee arthroplasty, and time to the activity after the operation to be predictive factors of DVT. At 6-month follow-up of the thrombus group, 4.7% of patients had pulmonary embolism and 18.8% had recurrent DVT; there were no deaths.Conclusions:Obesity, inactivity after operation, elevated preoperative Hcy and postoperative FBG, long operative duration, and bilateral knee arthroplasty were risk factors for DVT in patients aged over 70 years.

Evaluation of cardiac masses by real-time perfusion imaging echocardiography.

BackgroundDiagnosis of cardiac masses is still challenging by echocardiography and distinguishing tumors from thrombi has important therapeutical implications. We sought to determine the diagnostic value of real-time perfusion echocardiography (RTPE) for cardiac masses characterization.MethodsWe prospectively studied 86 patients, 23 with malignant tumors (MT), 26 with benign tumors (BT), 33 with thrombi and 6 with pseudotumors who underwent RTPE. Mass perfusion was analyzed qualitatively and blood flow volume (A), blood flow velocity (β), and microvascular blood flow (A x β) were determined by quantitative RTPE.ResultsLogistic regression models showed that the probability of having a tumor increased by 15.8 times with a peripheral qualitative perfusion pattern, and 34.5 times with a central perfusion pattern, in comparison with the absence of perfusion. Using quantitative RTPE analysis, thrombi group had parameters of blood flow lower than tumor group. A values for thrombi, MT, and BT were 0.1 dB (0.01-0.22), 2.78 dB (1–7) and 2.58 dB (1.44-5), respectively; p < 0.05, while A x β values were 0.0 dB/s−1 (0.01–0.14), 2.00 dB/s−1 (1–6), and 1.18 dB/s−1 (0.52–3), respectively; p < 0.05. At peak dipyridamole stress, MT had greater microvascular blood volume than BT [A = 4.18 dB (2.14-7.93) versus A = 2.04 dB (1.09-3.55); p < 0.05], but no difference in blood flow [Axβ = 2.46 dB/s−1 (1.42–4.59) versus Axβ = 1.55 dB/s [1] (0.51-4.08); p = NS]. An A value >3.28 dB at peak dipyridamole stress predicted MT (AUC = 0.75) and conferred 5.8-times higher chance of being MT rather than BT.ConclusionRTPE demonstrated that cardiac tumors have greater microvascular blood volume and regional blood flow when compared with thrombi. Dipyridamole stress was useful in differentiating MT from BT.

Impact of left atrium size on left atrial thrombus in patients with non-valvular persistent atrial fibrillation

This study sought to investigate the impact of left atrium size on left atrial (LA) thrombus in patients with non-valvular persistent atrial fibrillation (AF). In a prospectively established database, patients with AF underwent transesophageal echocardiography prior to AF ablation were screened from January 2007 to June 2010. Exclusive criteria included paroxysmal AF, vavular AF, deep vein thrombus, pulmonary embolism, on warfarin, redo procedure. Of 1 524 patients, 367 patients (male 267, female 100) with age 26-89 (mean 56±11) were enrolled. The patients were divided into LA thrombus group and non-thrombus group. Receptor-operating curves were used to test the value of CHA2DS2Vasc score and LA diameter predicting LA thrombus. Logistic analysis were used to find the independent predictor of LA thrombus. Thirty-two (8.7%) patients had LA thrombus. The LA diameter, left ventricular end diastolic diameter, left ventricular end systolic diameter were significantly larger in thrombus group than non-thrombus group. Left ventricular ejection fraction was significantly lower in thrombus group than non-thrombus group. CHA2DS2Vasc score did not differ between the two groups. The area under the receptor-operating curve for LA diameter predicting LA thrombus was 0.656 (0.563-0.750), the best cut-off point was 42.5 mm. The incidence of LA thrombus was significantly higher in patients with LA diameter≥42.5 mm than those with LA<42.5 mm (14.0% vs. 5.1%, χ2=8.888, P=0.003). In univariate analysis, LA diameter≥42.5 mm increased the risk of LA thrombus with odds ratio 3.05 (95% confidence interval 1.42-6.53, P=0.004. The sensitivity and specificity of LA diameter≥42.5 mm in predicting LA thrombus were 67.7% and 61.5%, respectively. In multivariate analysis, after adjustment of CHA2DS2Vasc score, left ventricular end diastolic diameter, left ventricular end systolic diameter, left ventricular ejection fraction, LA diameter≥42.5 mm was an independent risk factor of LA thrombus (odds ratio 2.77, 95% confidence interval 1.17-6.57, P=0.021). LA enlargement is an independent risk factor of LA thrombus in patients with non-vavular persistent AF.

McConnell’s sign; a distinctive echocardiographic finding for diagnosing acute pulmonary embolism in emergency department

Patients and methods From June 2013 through August 2014, 15 patients who were observed McConnell’s sign from bedside echocardiography performed by emergency medicine specialist were enrolled in this study. Those whose final diagnosis was acute pulmonary embolism were classified into three groups such as main, lobar and segmental pulmonary artery thrombus group according to the thrombus location based on the CT scan. Demographic and various clinical data were recorded and analyzed.

Clinical outcome and morphologic determinants of mural thrombus in abdominal aortic endografts

Endograft mural thrombus has been associated with stent graft or limb thrombosis after endovascular aneurysm repair (EVAR). This study aimed to identify clinical and morphologic determinants of endograft mural thrombus accumulation and its influence on thromboembolic events after EVAR. A prospectively maintained database of patients treated by EVAR at a tertiary institution from 2000 to 2012 was analyzed. Patients treated for degenerative infrarenal abdominal aortic aneurysms and with available imaging for thrombus analysis were considered. All measurements were performed on three-dimensional center-lumen line computed tomography angiography (CTA) reconstructions. Patients with thrombus accumulation within the endograft's main body with a thickness >2 mm and an extension >25% of the main body's circumference were included in the study group and compared with a control group that included all remaining patients. Clinical and morphologic variables were assessed for association with significant thrombus accumulation within the endograft's main body by multivariate regression analysis. Estimates for freedom from thromboembolic events were obtained by Kaplan-Meier plots. Sixty-eight patients (16.4%) presented with endograft mural thrombus. Median follow-up time was 3.54 years (interquartile range, 1.99-5.47 years). In-graft mural thrombus was identified on 30-day CTA in 22 patients (32.4% of the study group), on 6-month CTA in 8 patients (11.8%), and on 1-year CTA in 17 patients (25%). Intraprosthetic thrombus progressively accumulated during the study period in 40 patients of the study group (55.8%). Overall, 17 patients (4.1%) presented with endograft or limb occlusions, 3 (4.4%) in the thrombus group and 14 (4.1%) in the control group (P = .89). Thirty-one patients (7.5%) received an aortouni-iliac (AUI) endograft. Two endograft occlusions were identified among AUI devices (6.5%; overall, 0.5%). None of these patients showed thrombotic deposits in the main body, nor were any outflow abnormalities identified on the immediately preceding CTA. Estimated freedom from thromboembolic events at 5 years was 95% in both groups (P = .97). Endograft thrombus accumulation was associated with >25% proximal aneurysm neck thrombus coverage at baseline (odds ratio [OR], 1.9; 95% confidence interval [CI], 1.1-3.3), neck length ≤ 15 mm (OR, 2.4; 95% CI, 1.3-4.2), proximal neck diameter ≥ 30 mm (OR, 2.4; 95% CI, 1.3-4.6), AUI (OR, 2.2; 95% CI, 1.8-5.5), or polyester-covered stent grafts (OR, 4.0; 95% CI, 2.2-7.3) and with main component "barrel-like" configuration (OR, 6.9; 95% CI, 1.7-28.3). Mural thrombus formation within the main body of the endograft is related to different endograft configurations, main body geometry, and device fabric but appears to have no association with the occurrence of thromboembolic events over time.

Abstract T MP60: Impact of Aortic Arch Atheroma for Stroke Recurrence in Patients With or Without Atrial Fibrillation

Background &amp; Purpose: In patients with embolic stroke of undetermined source, aortic arch atheroma evaluated using transesophageal echocardiography (TEE) is a possible embolic source. We investigated the impact of embolic sources including aortic arch atheroma for a stroke recurrences and death. Methods: Among the consecutive 1545 acute stroke patients, 542 patients who were admitted within 24 hours after the symptom onset, with ischemic lesions in the cortex or cerebellum on the diffusion-weighted image, NIH stroke scale of 7 or less, and prior modified Rankin scale (mRS) of 0 or 1 were included in the present study. All 542 patients underwent TEE to search for embolic sources. According to the categories of embolic sources, patients were classified into 4 groups: patients with severe aortic arch atheroma of 4mm or more in diameter (group A; n=167), patients with cardiogenic embolic sources such as atrial fibrillation or intracardiac thrombus (group C; n=93), patients with both factors as described above (group B; n=88), and other patients (group O; n=194). We followed them up for average period of 3.2 years, and investigated the frequency of stroke recurrences and death from any cause according to embolic sources. Results: Stroke recurrences were observed in 12.0% patients in group A, 11.8% patients in group C, 18.2% patients in group B, and 6.7% patients in group O respectively (p=0.0371). Stroke recurrences and death from any cause occurred in 14.4%, 15.1%, 21.6% and 6.7% patients respectively (p=0.0041). Kaplan-Meier curve analysis revealed a significant difference in the recurrence-free survival among the four groups (p=0.0076, log-rank test). Stroke recurrence was more frequent in group B than group C patients especially in the early phase from the onset. On COX proportional-hazards model analysis and diabetes mellitus (HR 1.73, p=0.0264) and aortic arch atheroma of 4mm or more (HR 1.86, p=0.0146) were significant predictors for stroke recurrences and death from any cause. Conclusions: Severe aortic arch atheroma can independently be associated with stroke recurrences and death, furthermore, a combination of aortic arch atheroma and cardiogenic embolic sources showed more frequent events than each of them alone.

The blood flow channel index as novel predictor of abdominal aortic aneurysm impending rupture based on the intraluminal thrombus angio-CT study

ObjectiveIn this study the hypothesis that the thickness of the thinnest part of the thrombus, combined with bleeding into the intraluminal thrombus (ILT), is associated with a possible higher risk of abdominal aortic aneurysm (AAA) rupture was investigated, independently of aneurysm diameter, by using angio-CT. This article describes blood flow channel index based on the CT imaging findings that may help identify impending rupture prior to complete rupture. MethodsComputed tomographic images of 310 hospitalized patients with infrarenal AAA, were collected over a three-year period. They were divided into two main groups: 125 with bleeding into the ILT and control group 185 without the presence of blood in the thrombus. Patients were also analyzed in subgroups with ruptured, symptomatic and asymptomatic AAAs. A blood flow channel index was formulated as: maximal/minimal thickness ratio of thrombus from the same CT scan. ResultsIn dissected ILT group blood flow channel index was over a twofold higher than in group with intact ILT (19.0 [1.2–89.3] vs. (9.7 [1.3–38.9]; p<0.001), respectively. Median thickness at the thinnest part of the ILT in dissected thrombus group was lower (1.3mm [0.3–16.0]) than in group with intact ILT (1.7mm [0.2–23.4]; p<0.003). ConclusionAn association between a high blood flow channel index and bleeding into the ILT based on angio-CT study was demonstrated, and can suggest the aneurysm propensity for rupture.

Prognostic Outcomes and Risk Factors for Patients with Renal Cell Carcinoma and Venous Tumor Thrombus after Radical Nephrectomy and Thrombectomy: The Prognostic Significance of Venous Tumor Thrombus Level.

Introduction. To evaluate the prognostic outcomes and risk factors for renal cell carcinoma (RCC) patients with venous tumor thrombus in China. Materials and Methods. We reviewed the clinical information of 169 patients who underwent radical nephrectomy and thrombectomy. Overall and cancer-specific survival rates were analyzed. Univariate and multivariate analyses were used to investigate the potential prognostic factors. Results. The median survival time was 63 months. The five-year overall survival and cancer-specific survival rate were 53.6% and 54.4% for all patients. For all patients, significant survival difference was only observed between early (below hepatic vein) and advanced (above hepatic vein) tumor thrombus. However, significant differences existed between both RV/IVC and early/advanced tumor thrombus groups in N0M0 patients. Multivariate analysis demonstrated that higher tumor thrombus level (p = 0.016, RR = 1.58), N (p = 0.013, RR = 2.60), and M (p < 0.001, RR = 4.14) stages and adrenal gland invasion (p = 0.001, RR = 4.91) were the most significant negative prognostic predictors. Conclusions. In this study, we reported most cases of RCC patients with venous extension in China. We proved that patients with RCC and venous tumor thrombus may have relative promising long-term survival rate, especially those with early tumor thrombus.