Objectives To investigate the clinical features, pathological findings, and risk factors of intracardiac thrombus (ICT) in Behçet’s syndrome (BS). Methods We conducted a case–control study using our BS registry database. BS patients with ICT were enrolled as the cases, and controls were selected using risk-set-sampling. Multivariable logistic regression identified risk factors, and outcomes were also analyzed. Pathology of six ICT specimens was reanalyzed by preoperative disease activity. Results Seventeen BS patients with ICT (14 males, 3 females, BS onset age: 26.4 ± 8.0 years) were enrolled. Compared to controls, ICT patients had higher venous involvement (70.6% vs. 13.7%, p < 0.001), pulmonary artery thrombosis (64.7% vs. 3.9%, p < 0.001), elevated ESR (26.0 vs. 9.8 mm/h, p = 0.013), CRP (34.7 vs. 10.1 mg/L, p < 0.001), and monocyte count (0.5 vs. 0.4*10^9/L, p = 0.024). Multivariable logistic regression identified CRP > 20 mg/L (OR 11.27, 95% CI 1.13–112.26, p = 0.039) and venous involvement (OR 11.71, 95% CI 2.79–49.20, p < 0.001) as ICT risk factors. Pathology revealed increased infiltration of neutrophils and CD68+macrophages, which was more prominent in active cases. With a follow-up of 35.7 ± 24.8 months, 1- and 3- year survival rates were both 88.2%, and the relapse-free rates were 81.3% and 54.2%. Conclusion ICT in BS is a severe complication with a high relapse rate and pathological features of neutrophils and macrophages’ infiltration. Elevated CRP (> 20 mg/L) and venous involvement are potential risk factors. These findings support the potential benefit of adequate immunosuppressive treatment before surgery for improving outcomes in BS patients with ICT. <Table Float="No" ID="Taba"> <tgroup cols="2"> <colspec align="left" colname="c1" colnum="1" /> <colspec align="left" colname="c2" colnum="2" /> <tbody> <row> <entry align="left" nameend="c2" namest="c1"> Key Points • ICT is a serious complication of BS, with a high relapse rate. • CRP > 20 mg/L and venous involvement are potential risk factors for ICT in BS. • Adequate immunosuppressive treatment before surgery is essential for improving outcomes in BS patients with ICT. </entry> </row> </tbody> </tgroup> </Table>

The clinical features, pathological findings, and risk factors of intracardiac thrombus in Behçet’s syndrome

期刊论文
发表日期：

2025年12月2日

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Xiaoou Wang,
Hongqin Dai,
Xun Wang,
Weida Liu,
Xin Yu,
Menghao Zhang,
Yeling Liu,
Yiyuan Ao,
Jinjing Liu,
Qi Miao,
Wenze Wang,
Jun Zheng,
Wenjie Zheng

摘要

Objectives

To investigate the clinical features, pathological findings, and risk factors of intracardiac thrombus (ICT) in Behçet’s syndrome (BS).

Methods

We conducted a case–control study using our BS registry database. BS patients with ICT were enrolled as the cases, and controls were selected using risk-set-sampling. Multivariable logistic regression identified risk factors, and outcomes were also analyzed. Pathology of six ICT specimens was reanalyzed by preoperative disease activity.

Results

Seventeen BS patients with ICT (14 males, 3 females, BS onset age: 26.4 ± 8.0 years) were enrolled. Compared to controls, ICT patients had higher venous involvement (70.6% vs. 13.7%, p < 0.001), pulmonary artery thrombosis (64.7% vs. 3.9%, p < 0.001), elevated ESR (26.0 vs. 9.8 mm/h, p = 0.013), CRP (34.7 vs. 10.1 mg/L, p < 0.001), and monocyte count (0.5 vs. 0.4*10^9/L, p = 0.024). Multivariable logistic regression identified CRP > 20 mg/L (OR 11.27, 95% CI 1.13–112.26, p = 0.039) and venous involvement (OR 11.71, 95% CI 2.79–49.20, p < 0.001) as ICT risk factors. Pathology revealed increased infiltration of neutrophils and CD68⁺macrophages, which was more prominent in active cases. With a follow-up of 35.7 ± 24.8 months, 1- and 3- year survival rates were both 88.2%, and the relapse-free rates were 81.3% and 54.2%.

Conclusion

ICT in BS is a severe complication with a high relapse rate and pathological features of neutrophils and macrophages’ infiltration. Elevated CRP (> 20 mg/L) and venous involvement are potential risk factors. These findings support the potential benefit of adequate immunosuppressive treatment before surgery for improving outcomes in BS patients with ICT.

Key Points

• ICT is a serious complication of BS, with a high relapse rate.

• CRP > 20 mg/L and venous involvement are potential risk factors for ICT in BS.

• Adequate immunosuppressive treatment before surgery is essential for improving outcomes in BS patients with ICT.