{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T09:04:45Z","timestamp":1784019885717,"version":"3.55.0"},"reference-count":24,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T00:00:00Z","timestamp":1783382400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Background: The significance of imaging right-heart thrombus via echocardiography in acute pulmonary embolism (PE) patients, as well as its management, remains uncertain. Methods: In this retrospective, observational, multicenter, and multinational registry of consecutive acute PE patients, we compared 100 patients in whom thrombus was visualized in the right heart during echocardiographic evaluation with 2635 patients without visualization of thrombus. The co-primary endpoints were all-cause in-hospital mortality and PE-related mortality. Secondary endpoints included the prevalence of severe PE at admission (intermediate\u2013high and high-risk PE), the frequency of thrombolytic therapy administration, and mortality among patients who received thrombolysis. Results: All-cause and PE-related mortality were higher in patients with thrombus in the right heart (31.0% vs. 9.6%, and 25.8% vs. 5.6%, p &lt; 0.001, respectively). Patients with right-heart thrombi had a more severe PE presentation than those without (74.0% vs. 45.3%, p &lt; 0.001). In patients treated with thrombolysis, all-cause mortality was higher in patients with right-heart thrombi (35.5% vs. 12.7%, p &lt; 0.001). In the multivariable Cox regression analysis adjusted for ESC mortality risk, age, presence of syncope, atrial fibrillation, and hypoxemia, patients with thrombus in the right heart had a significantly higher risk of all-cause and PE-related death compared to patients without thrombus (HR 2.60, 95% CI 1.753\u20133.859, p &lt; 0.001, and HR 3.287, 95% CI 2.056\u20135.253, p &lt; 0.001, respectively). Conclusions: Visualization of thrombus in transit through the right heart is associated with higher all-cause and PE-related mortality, independent of PE severity and the use of thrombolytic therapy.<\/jats:p>","DOI":"10.3390\/life16071131","type":"journal-article","created":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T13:19:31Z","timestamp":1783430371000},"page":"1131","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prognostic Significance of Echocardiography-Visualized Thrombus in Right Heart in Early Stages of Acute PE: 100 Patients from Regional Pulmonary Embolism Registry"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0921-7911","authenticated-orcid":false,"given":"Bojan","family":"Mitrovic","sequence":"first","affiliation":[{"name":"Clinic of Internal Medicine, Clinical-Hospital Centre Zemun, 11000 Belgrade, Serbia"},{"name":"Faculty of Medicine, University in Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-5453-3732","authenticated-orcid":false,"given":"M.","family":"Radovic","sequence":"additional","affiliation":[{"name":"Clinic of Internal Medicine, Clinical-Hospital Centre Zemun, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5656-5524","authenticated-orcid":false,"given":"L.","family":"Kos","sequence":"additional","affiliation":[{"name":"Clinic of Cardiology, Clinical Center Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina"},{"name":"Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7100-5189","authenticated-orcid":false,"given":"Tamara","family":"Kovacevic-Preradovic","sequence":"additional","affiliation":[{"name":"Clinic of Cardiology, Clinical Center Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina"},{"name":"Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9665-6052","authenticated-orcid":false,"given":"B.","family":"Dzudovic","sequence":"additional","affiliation":[{"name":"Clinic of Emergency Internal Medicine, Military Medical Academy, 11000 Belgrade, Serbia"},{"name":"Faculty of Medicine, University of Defense, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9657-1665","authenticated-orcid":false,"given":"S.","family":"Salinger","sequence":"additional","affiliation":[{"name":"Clinic of Cardiology, Clinical Center Nis, 18000 Nis, Serbia"},{"name":"Faculty of Medicine, University of Nis, 18000 Nis, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8528-6017","authenticated-orcid":false,"given":"E.","family":"Jevtic","sequence":"additional","affiliation":[{"name":"Clinic of Cardiology, Clinical Center Kragujevac, 34000 Kragujevac, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V.","family":"Miloradovic","sequence":"additional","affiliation":[{"name":"Clinic of Cardiology, Clinical Center Kragujevac, 34000 Kragujevac, Serbia"},{"name":"Faculty of Medicine, University of Kragujevac, 34000 Kragujevac, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2774-8559","authenticated-orcid":false,"given":"I.","family":"Mitevska","sequence":"additional","affiliation":[{"name":"University Clinic for Cardiology and Cardiovascular Surgery, National Center for Cardiovascular Disease, 1000 Skopje, North Macedonia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B.","family":"Bozovic","sequence":"additional","affiliation":[{"name":"University Cardiology Clinic Podgorica, 81000 Podgorica, Montenegro"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Pekovic","sequence":"additional","affiliation":[{"name":"Institute of Pulmonary Diseases Vojvodina, 21208 Sremska Kamenica, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Matijasevic","sequence":"additional","affiliation":[{"name":"Institute of Pulmonary Diseases Vojvodina, 21208 Sremska Kamenica, Serbia"},{"name":"Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Biskupovic","sequence":"additional","affiliation":[{"name":"General Hospital Pancevo, 24000 Pancevo, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6371-6610","authenticated-orcid":false,"given":"Z.","family":"Gluvic","sequence":"additional","affiliation":[{"name":"Clinic of Internal Medicine, Clinical-Hospital Centre Zemun, 11000 Belgrade, Serbia"},{"name":"Faculty of Medicine, University in Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Kafedzic","sequence":"additional","affiliation":[{"name":"Clinic of Internal Medicine, Clinical-Hospital Centre Zemun, 11000 Belgrade, Serbia"},{"name":"Faculty of Medicine, University in Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Neskovic","sequence":"additional","affiliation":[{"name":"Clinic of Internal Medicine, Clinical-Hospital Centre Zemun, 11000 Belgrade, Serbia"},{"name":"Faculty of Medicine, University in Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5711-5851","authenticated-orcid":false,"given":"Slobodan","family":"Obradovic","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Defense, 11000 Belgrade, Serbia"},{"name":"Clinic of Cardiology, Military Medical Academy, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1093\/eurheartj\/ehz405","article-title":"2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS)","volume":"41","author":"Konstantinides","year":"2020","journal-title":"Eur. 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