Cardio Oncology

1353715 - Embolic Risk of Cardiac Magnetic Resonance Evidenced Catheter-Associated Right Atrial Thrombus in Cancer Patients

Thursday, January 26, 2023

4:30 PM – 5:10 PM

Location: Pacific Jewel

Presenting Author(s)

MP

Michael Park, MD

Fellow
Memorial Sloan Kettering Cancer Center
Long island city, New York, United States

Primary Author(s)

MP

Michael Park, MD

Fellow
Memorial Sloan Kettering Cancer Center
Long island city, New York, United States

Co-Author(s)

CP

Christine Park, MD

Resident
Memorial Sloan Kettering Cancer Center, United States
RJ

Raina Jain, MD

Resident
Weill Cornell Medicine, United States
NL

Nicole Liberman, BA

Research Assistant
Weill Cornell Medicine, United States
HA

Hannah Agoglia, BSc

Research Assistant
Weill Cornell Medicine, United States
RS

Richard Steingart, MD

Professor of Medicine
Memorial Sloan Kettering Cancer Center
New York, New York, United States
Jiwon Kim, MD

Associate Professor of Medicine
Weill Cornell Medicine
New York, New York, United States
Jonathan W. Weinsaft, MD

Professor of Medicine
Weill Cornell Medical College
New York, New York, United States
AC

Angel Chan, MD, PhD

Attending Physician
Memorial Sloan Kettering Cancer Center
New York, New York, United States

Disclosure(s):

Jiwon Kim, MD: No financial relationships to disclose

Jonathan W. Weinsaft, MD: No relevant disclosure to display

Background: Late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) is a validated reference for cardiac thrombus. Cancer patients with central venous catheters are at high risk for right atrial thrombus (RA-Thr); incidence and predictors of embolic risk among patients with LGE-CMR evidenced RA-Thr is unknown.

Methods: CMR was performed for clinical indications in systemic cancer patients using a standardized CMR protocol on commercial (1.5T, 3.0T GE) scanners. RA-Thr was identified as a cardiac mass with uniform avascularity, as established using tailored long inversion time (TI=600 msec) LGE-CMR tissue characterization (acquired 5-10 minutes post gadolinium [0.2 mmol/kg] infusion (Figure 1). Cine-CMR was used as a secondary means to assess RA-Thr mobility and quantify cardiac chamber remodeling. Electronic medical records were queried for pulmonary embolism (PE) at time (within 30 days) of, or within 6 months following CMR.

Results: 132 cancer patients (51.2 ± 17.0 yo, 53.8% M) were retrospectively studied, inclusive of 72 with LGE-CMR evidenced RA-Thr and 60 controls matched 1:1 for cancer type and stage (leading cancer types: 28.8% GI, 18.9% lymphoma, 15.9% sarcoma). Patients with and without RA-Thr were similar with respect to clinical characteristics; quantitative RV and LVEF was slightly higher in RA-Thr patients and prevalence of dysfunction (EF< 50%) was lower (Table 1). During median follow-up of 10 months [IQR 4-27], 16.7% (n=12) of patients with RA-Thr had PE, including 3 (4.2%) with incident events at time of CMR and 9 (12.5%) with new onset symptoms and imaging (CT) verified PE at followup (median time to event 2.13 months [IQR 0.9-3.3]). The incidence of PE among RA-Thr patients were similar with respect to thrombus shape/size (2.9 ± 1.9 mm² vs 2.7 ± 4.0 mm², p = 0.88) and RA chamber size (16.5 ± 4.8 cm² vs 17.4 ± 5.1cm², p = 0.58). Embolic events were more common in RA-Thr with high mobility as determined by cine-CMR imaging (58.3% vs. 20%, p = 0.006) (Table 2). All RA-Thr patients who developed PE on follow up were actively treated with anticoagulation (low molecular weight heparin 67%, direct oral anticoagulants 33%) at time of event. When compared to RA-Thr patients and their respective matched controls, embolic events were 3-fold (16.7% vs. 5%, p=0.04) higher among in patients with RA-Thr than controls.

Conclusion: Among patients with systemic cancer and central venous catheters, LGE-CMR evidenced RA-Thr associates with increased rate pulmonary embolism compared to cancer-matched controls, especially in patients with highly mobile RA-Thr on cine-CMR. Embolic events occurred despite anticoagulant therapy, support need for targeted antithrombic therapies to mitigate embolic events in patients deemed high risk by CMR.