What does this research mean for the field?

Spontaneous echocardiographic contrast and left ventricular thrombus independently predict ischemic stroke in patients with HFrEF, and systemic anticoagulation may mitigate this risk even in those with sinus rhythm. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

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January 25, 2021Open Access

The Prevalence, Predictors, and Outcomes of Spontaneous Echocardiographic Contrast or Left Ventricular Thrombus in Patients with HFrEF

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Heart failure with reduced ejection fraction (HFrEF) (n=9485). Intervention: Spontaneous echocardiographic contrast (SEC) or left ventricular thrombus (LVT) vs. No SEC or LVT. Primary outcome: Ischaemic stroke occurrence (HR 2.40 (SEC), HR 4.52 (LVT), 95% CI 1.74-3.31 (SEC), 2.77-7.40 (LVT), p=<0.001).

Key Result

Spontaneous echocardiographic contrast and left ventricular thrombus independently predicted ischemic stroke in HFrEF patients (HR 2.40 and HR 4.52, respectively; both P<0.001).

Study Design

Type

Cohort (n=9,485)

Structured PICO

Does the presence of spontaneous echocardiographic contrast or left ventricular thrombus increase the risk of ischaemic stroke in patients with HFrEF?

Population

9,485 consecutive patients with heart failure with reduced ejection fraction (HFrEF), defined as left ventricular ejection fraction < 40% by echocardiography on admission.

Intervention

Presence of spontaneous echocardiographic contrast (SEC) or left ventricular thrombus (LVT)

Comparator

Absence of spontaneous echocardiographic contrast (SEC) or left ventricular thrombus (LVT)

Outcome

Ischaemic stroke occurrencehard clinical

In patients with HFrEF, the presence of spontaneous echocardiographic contrast or left ventricular thrombus independently increases the risk of ischaemic stroke, suggesting a potential benefit for systemic anticoagulation even in sinus rhythm.

Main Result

Effect estimate: HR 2.40 (SEC), HR 4.52 (LVT) (95% CI 1.74-3.31 (SEC), 2.77-7.40 (LVT))

p-value: p=<0.001

Abstract

AIMS: This study aimed to determine prevalence, predictors, and association with ischaemic stroke risk of spontaneous echocardiographic contrast (SEC) or left ventricular thrombus (LVT) in patients with heart failure with reduced ejection fraction (HFrEF). METHODS AND RESULTS: Clinical, echocardiographic, and follow-up data from January 2009 through February 2019 were retrospectively extracted from electronic medical records of patients with heart failure with left ventricular ejection fraction 0.05). In patients with sinus rhythm, the associations between SEC/LVT and ischaemic stroke persist with HRs of 2.57 (95% CI: 1.69-3.92) and 5.74 (95% CI: 3.38-9.75). CONCLUSIONS: In patients with HFrEF, SEC was not uncommon and increased risk of ischaemic stroke as well as LVT. Anticoagulants could play a role in the reduction of stroke risk, suggesting that patients with SEC/LVT, even those in sinus rhythm, would benefit from systemic anticoagulation treatment.

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Cite This Study

Zhou et al. (Mon,) conducted a cohort in Heart failure with reduced ejection fraction (HFrEF) (n=9,485). Spontaneous echocardiographic contrast (SEC) or left ventricular thrombus (LVT) vs. No SEC or LVT was evaluated on Ischaemic stroke occurrence (HR 2.40 (SEC), HR 4.52 (LVT), 95% CI 1.74-3.31 (SEC), 2.77-7.40 (LVT), p=<0.001). Spontaneous echocardiographic contrast and left ventricular thrombus independently predicted ischemic stroke in HFrEF patients (HR 2.40 and HR 4.52, respectively; both P<0.001).

synapsesocial.com/papers/6a1ab5df37bfaf0f5945b99e https://doi.org/https://doi.org/10.1002/ehf2.13196

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