Cancer-associated left ventricular thrombus with preserved ejection fraction: A multicenter descriptive study

Introduction Left ventricular thrombus (LVT) is usually associated with reduced left ventricular ejection fraction (LVEF), yet malignancy-related hypercoagulability may promote LVT despite preserved systolic function. Methods We performed a retrospective descriptive cohort study across three Mayo Clinic tertiary centers. Adults with confirmed LVT, active malignancy, and preserved LVEF, defined as LVEF ≥50% at LVT diagnosis, were included. Outcomes included all-cause mortality, ischemic stroke or transient ischemic attack, clinically significant bleeding, LVT resolution, and discharge anticoagulation strategy. Results Twenty-three patients were included. Mean age was 66 years, 17 patients were men, and mean LVEF was 57.3%. All-cause mortality occurred in 14 patients, clinically significant bleeding in 5, and no ischemic stroke or transient ischemic attack events were observed. LVT resolution occurred in 20 patients. At discharge, 6 received direct oral anticoagulants and 17 received warfarin. Discussion Cancer-associated LVT may occur despite preserved LVEF and identifies a high-risk phenotype requiring further study.