Key result
LVT resolution linked to ~55% lower risk of death and thromboembolic events.
Why the study?
Treatment strategies for left ventricular thrombus in patients with impaired LV systolic function have not yet been fully established.
Does left ventricular thrombus (LVT) resolution reduce the risk of a composite of all-cause death, stroke, transient ischaemic attack, and arterial thromboembolic events in patients with LVT and LVEF < 50%?
Cohort (n=212)
No
Does left ventricular thrombus (LVT) resolution reduce the risk of a composite of all-cause death, stroke, transient ischaemic attack, and arterial thromboembolic events in patients with LVT and LVEF < 50%?
Hazard Ratio: 0.45 (95% CI 0.21–0.98)
Absolute Event Rate: 12.8% vs 27.3%
p-value: p=0.045
Left ventricular thrombus resolution is strongly associated with a reduced risk of death and thromboembolic events, and failure of LVEF to improve significantly hinders this resolution.
AIMS: A left ventricular thrombus (LVT) is not uncommon in patients with impaired LV systolic function. However, the treatment strategy for LVT has not yet been fully established. We aimed to identify the factors influencing LVT resolution and the significance of LVT resolution on clinical outcomes. METHODS: We retrospectively investigated patients diagnosed with LVT with left ventricular ejection fraction (LVEF) < 50% on transthoracic echocardiography from January 2010 to July 2021 in a single tertiary centre. LVT resolution was monitored through serial follow-up transthoracic echocardiography. The primary clinical outcome was a composite of all-cause death, stroke, transient ischaemic attack, and arterial thromboembolic events. LVT recurrence was also evaluated in patients with LVT resolution. RESULTS: There were 212 patients diagnosed with LVT (mean age, 60.5 ± 14.0 years; male, 82.5%). The mean LVEF was 33.1 ± 10.9%, and 71.7% of patients were diagnosed with ischaemic cardiomyopathy. Most patients were treated with vitamin K antagonists (86.7%), and 28 patients (13.2%) were treated with direct oral anticoagulants or low molecular weight heparin. LVT resolution was observed in 179 patients (84.4%). LVEF improvement failure within 6 months was a significant factor hindering LVT resolution (hazard ratio, HR: 0.52, 95% confidence interval, CI: 0.31-0.85, P = 0.010). During a median 4.0 years of follow-up (interquartile range, IQR: 1.9 to 7.3 years), 32 patients (15.1%) experienced primary outcomes (18 all-cause deaths, 15 strokes, and 3 arterial thromboembolisms) and 20 patients (11.2%) experienced LVT recurrence after LVT resolution. LVT resolution was independently associated with a lower risk for primary outcomes (HR: 0.45, 95% CI: 0.21-0.98, P = 0.045). In the patients with resolved LVT, discontinuation or duration of anticoagulation after resolution were not significant predictors for LVT recurrence, but LVEF improvement failure at LVT resolution was associated with a significantly higher risk of LVT recurrence (HR: 3.10, 95% CI: 1.23-7.78, P = 0.016). CONCLUSIONS: This study suggests that LVT resolution is an important predictor for favourable clinical outcomes. LVEF improvement failure interfered with LVT resolution and appeared to be a crucial factor for LVT recurrence. After LVT resolution, continuation of anticoagulation did not seem to impact LVT recurrence and the prognosis.
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Kim et al. (2023) conducted a cohort in Left ventricular thrombus (LVT) with left ventricular ejection fraction (LVEF) < 50% (n=212). Left ventricular thrombus (LVT) resolution vs. Persistent left ventricular thrombus was evaluated on Composite of all-cause death, stroke, transient ischaemic attack, and arterial thromboembolic events (HR 0.45, 95% CI 0.21-0.98, p=0.045). Left ventricular thrombus (LVT) resolution was independently associated with a 55% lower risk of the primary composite outcome of death and thromboembolic events (HR 0.45).
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