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Clinical characteristics of patients with fresh left ventricular thrombus
Insights
Fresh left ventricular thrombus (LVT) in severe heart failure patients may develop after diuretic therapy. Early anticoagulant therapy is recommended to resolve LVT and prevent complications.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- Left ventricular thrombus (LVT) is a serious complication in patients with severe congestive heart failure.
- Left ventricular systolic dysfunction is a common finding in these patients.
Purpose of the Study:
- To analyze the clinical characteristics of patients with fresh left ventricular thrombus (LVT).
- To investigate the relationship between diuretic therapy and LVT formation in heart failure patients.
Main Methods:
- Retrospective analysis of 9 patients with LVT detected via echocardiography over 5 years.
- Exclusion of patients with acute myocardial infarction.
- Echocardiography performed before and after furosemide therapy in some patients.
Main Results:
- All patients exhibited impaired left ventricular systolic function (mean ejection fraction 33%).
- LVT was detected shortly after furosemide therapy in 7 out of 9 patients with severe congestive heart failure.
- LVT resolved in 7 patients within 6 months of anticoagulant therapy without thromboembolic events.
Conclusions:
- Fresh LVT can develop in severe congestive heart failure patients with systolic dysfunction, potentially linked to diuretic therapy.
- Anticoagulant therapy is recommended for LVT in this patient population to prevent thromboembolic complications.
Abstract:
The present study analyzed the clinical backgrounds of 9 patients with fresh left ventricular thrombus (LVT) detected by two-dimensional echocardiography during the past 5 years. Patients with acute myocardial infarction were excluded. Left ventricular systolic function was disturbed either diffusely or segmentally in all patients with a mean ejection fraction of 33%. In 7 patients, echocardiography was performed shortly after furosemide therapy for New York Heart Association class IV congestive heart failure; echocardiography was also performed just before treatment in 4 of the 7 patients and LVT was not detected in any of them. Two patients died of underlying disorders within 2 months of detection of the thrombus. However, the LVT disappeared in the other 7 patients without any thromboembolic episodes during the 6 months after starting anticoagulant therapy. As fresh LVT developed shortly after diuretic therapy in patients with severe congestive heart failure associated with left ventricular systolic dysfunction, concomitant anticoagulant therapy is recommended.