Total left ventricular thrombus regression was associated with reduced mortality (HR 0.48; 95% CI 0.23-0.98; p=0.039) compared to persistent thrombus, though MACE rates were similar (35.4% vs 40.0%).
Cohort (n=159)
Does anticoagulation therapy and subsequent LVT regression reduce mortality and MACE in patients with left ventricular thrombus?
In patients with left ventricular thrombus, total thrombus regression is associated with reduced mortality, and anticoagulation for >3 months is associated with fewer major adverse cardiovascular events.
Absolute Event Rate: 35.4% vs 40%
p-value: p=0.203
BACKGROUND Contemporary data are lacking regarding the prognosis and management of left ventricular thrombus (LVT). OBJECTIVES The purpose of this study was to quantify the effect of anticoagulation therapy on LVT evolution using sequential imaging and to determine the impact of LVT regression on the incidence of thromboembolism, bleeding, and mortality. METHODS From January 2011 to January 2018, a comprehensive computerized search of LVT was conducted using 90,065 consecutive echocardiogram reports. Only patients with a confirmed LVT were included after imaging review by 2 independent experts. Major adverse cardiovascular events (MACE), which included death, stroke, myocardial infarction, or acute peripheral artery emboli, were determined as well as major bleeding events (BARC ≥3) and all-cause mortality rates. RESULTS There were 159 patients with a confirmed LVT. Patients were treated with vitamin K antagonists (48.4%), parenteral heparins (27.7%), and direct oral anticoagulants (22.6%). Antiplatelet therapy was used in 67.9% of the population. A reduction of the LVT area from baseline was observed in 121 patients (76.1%), and total LVT regression occurred in 99 patients (62.3%) within a median time of 103 days (interquartile range: 32 to 392 days). The independent correlates of LVT regression were a nonischemic cardiomyopathy (hazard ratio HR: 2.74; 95% confidence interval CI: 1.43 to 5.26; p = 0.002) and a smaller baseline thrombus area (HR: 0.66; 95% CI: 0.45 to 0.96; p = 0.031). The frequency of MACE was 37.1%; mortality 18.9%; stroke 13.3%; and major bleeding 13.2% during a median follow-up of 632 days (interquartile range: 187 to 1,126 days). MACE occurred in 35.4% and 40.0% of patients with total LVT regression and those with persistent LVT (p = 0.203). A reduced risk of mortality was observed among patients with total LVT regression (HR: 0.48; 95% CI: 0.23 to 0.98; p = 0.039), whereas an increased major bleeding risk was observed among patients with persistent LVT (9.1% vs. 12%; HR 0.34; 95% CI: 0.14 to 0.82; p = 0.011). A left ventricular ejection fraction ≥35% (HR: 0.46; 95% CI: 0.23 to 0.93; p = 0.029) and anticoagulation therapy >3 months (HR: 0.42; 95% CI: 0.20 to 0.88; p = 0.021) were independently associated with less MACE. CONCLUSIONS The presence of LVT was associated with a very high risk of MACE and mortality. Total LVT regression, obtained with different anticoagulant regimens, was associated with reduced mortality.
Lattuca et al. (Wed,) conducted a cohort in Left ventricular mural thrombus (n=159). Total LVT regression vs. Persistent LVT was evaluated on Major adverse cardiovascular events (MACE) (p=0.203). Total left ventricular thrombus regression was associated with reduced mortality (HR 0.48; 95% CI 0.23-0.98; p=0.039) compared to persistent thrombus, though MACE rates were similar (35.4% vs 40.0%).