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Peer-reviewedCC BY 4.0Frontiers in Cardiovascular Medicine

Chamber-specific long-term prognosis of intracardiac thrombus: a 21-year propensity-matched cohort study

  • Victor Chien-Chia Wu1,2
  • Chih-Shan Liu2
  • Chun-Li Wang1,2
  • Ya-Chi Huang3,4
  • Hui-Tzu Tu3
  • Hsin-Jui Liao3
  • Yu-Tung Huang3
  • Shao-Wei Chen2,3,5
  • Chang-Fu Kuo2,6,7
  • Shang-Hung Chang1,2,3,8
8 affiliations
  1. 1Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center
  2. 2College of Medicine, Chang Gung University
  3. 3Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center
  4. 4Information System Division, Chang Gung Medical Technology Co., Ltd.
  5. 5Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou Medical Center
  6. 6Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Medical Center
  7. 7Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham
  8. 8Graduate Institute of Nursing, Chang Gung University of Science and Technology
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Abstract

Background: The prognostic impact of intracardiac thrombus varies by cardiac chamber, yet large-scale comparative long-term outcome data across all four chambers remain limited.

Methods: In this retrospective propensity-matched cohort study using the Chang Gung Research Database (2001–2022), we identified 1,541 patients in the final propensity-matched analytic cohorts with echocardiographically confirmed single-chamber intracardiac thrombus [left atrial (LA) n = 619, left ventricular (LV) n = 774, right atrial (RA) n = 125, right ventricular (RV) n = 23]. Patients were 1:4 matched with controls without thrombus for demographics, comorbidities, and medications. Primary outcomes included ischemic stroke/systemic embolism, pulmonary embolism, myocardial infarction, heart failure, cardiac death, and major adverse cardiovascular events (MACE; composite of the above). Follow-up continued until the first event, death, or December 31, 2022.

Findings: Compared with matched controls, LA thrombus was associated with increased risks of ischemic stroke/systemic embolism (hazard ratio, HR = 1.85), heart failure (HR = 1.30), cardiac death (HR = 2.02), and MACE (HR = 1.61). LV thrombus was associated with increased risks of ischemic stroke/systemic embolism (HR = 1.38), myocardial infarction (HR = 1.58), heart failure (HR = 1.40), cardiac death (HR = 1.32), and MACE (HR = 1.36). RA thrombus was associated with pulmonary embolism (HR = 4.63), heart failure (HR = 1.70), and MACE (HR = 1.63), whereas cardiac death was not significantly increased (HR = 1.96). RV thrombus was rare and showed no significant associations with any outcome. Left atrial appendage thrombus did not confer additional risk compared with non-appendage LA thrombus.

Conclusions: The prognostic impact of intracardiac thrombus is strongly location-dependent. LV and LA thrombi carried the broadest cardiovascular risks, RA thrombus was disproportionately linked to pulmonary embolism and mortality, and RV thrombus had limited long-term impact. These findings support chamber-specific risk stratification and management strategies for patients with echocardiography-detected intracardiac thrombus.

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Cite

BibTeXRIS
BibTeX
@article{wu2026chamberspecific,
  title = {{Chamber-specific long-term prognosis of intracardiac thrombus: a 21-year propensity-matched cohort study}},
  author = {Victor Chien-Chia Wu and Chih-Shan Liu and Chun-Li Wang and Ya-Chi Huang and Hui-Tzu Tu and Hsin-Jui Liao and Yu-Tung Huang and Shao-Wei Chen and Chang-Fu Kuo and Shang-Hung Chang},
  journal = {Frontiers in Cardiovascular Medicine},
  year = {2026},
  month = oct,
  doi = {10.3389/fcvm.2026.1889091},
  url = {https://www.frontiersin.org/articles/10.3389/fcvm.2026.1889091/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Chamber-specific long-term prognosis of intracardiac thrombus: a 21-year propensity-matched cohort study
AU  - Victor Chien-Chia Wu
AU  - Chih-Shan Liu
AU  - Chun-Li Wang
AU  - Ya-Chi Huang
AU  - Hui-Tzu Tu
AU  - Hsin-Jui Liao
AU  - Yu-Tung Huang
AU  - Shao-Wei Chen
AU  - Chang-Fu Kuo
AU  - Shang-Hung Chang
PY  - 2026
DA  - 2026/10/13
JO  - Frontiers in Cardiovascular Medicine
DO  - 10.3389/fcvm.2026.1889091
UR  - https://www.frontiersin.org/articles/10.3389/fcvm.2026.1889091/full
AB  - Background: The prognostic impact of intracardiac thrombus varies by cardiac chamber, yet large-scale comparative long-term outcome data across all four chambers remain limited.  Methods: In this retrospective propensity-matched cohort study using the Chang Gung Research Database (2001–2022), we identified 1,541 patients in the final propensity-matched analytic cohorts with echocardiographically confirmed single-chamber intracardiac thrombus [left atrial (LA) n = 619, left ventricular (LV) n = 774, right atrial (RA) n = 125, right ventricular (RV) n = 23]. Patients were 1:4 matched with controls without thrombus for demographics, comorbidities, and medications. Primary outcomes included ischemic stroke/systemic embolism, pulmonary embolism, myocardial infarction, heart failure, cardiac death, and major adverse cardiovascular events (MACE; composite of the above). Follow-up continued until the first event, death, or December 31, 2022.  Findings: Compared with matched controls, LA thrombus was associated with increased risks of ischemic stroke/systemic embolism (hazard ratio, HR = 1.85), heart failure (HR = 1.30), cardiac death (HR = 2.02), and MACE (HR = 1.61). LV thrombus was associated with increased risks of ischemic stroke/systemic embolism (HR = 1.38), myocardial infarction (HR = 1.58), heart failure (HR = 1.40), cardiac death (HR = 1.32), and MACE (HR = 1.36). RA thrombus was associated with pulmonary embolism (HR = 4.63), heart failure (HR = 1.70), and MACE (HR = 1.63), whereas cardiac death was not significantly increased (HR = 1.96). RV thrombus was rare and showed no significant associations with any outcome. Left atrial appendage thrombus did not confer additional risk compared with non-appendage LA thrombus.  Conclusions: The prognostic impact of intracardiac thrombus is strongly location-dependent. LV and LA thrombi carried the broadest cardiovascular risks, RA thrombus was disproportionately linked to pulmonary embolism and mortality, and RV thrombus had limited long-term impact. These findings support chamber-specific risk stratification and management strategies for patients with echocardiography-detected intracardiac thrombus.
SN  - 2297-055X
ER  -