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Ventricular thrombi and thromboembolism in dilated cardiomyopathy: a prospective follow-up study
Insights
Left ventricular thrombus is common in dilated cardiomyopathy patients not on anticoagulation. Echocardiography can help identify those at risk of thromboembolism.
Area of Science:
- Cardiology
- Cardiovascular Imaging
Background:
- Dilated cardiomyopathy is a significant cause of heart failure.
- Left ventricular thrombus formation is a known complication, increasing embolic risk.
Purpose of the Study:
- To assess the prevalence and natural history of left ventricular thrombus.
- To evaluate the association between thrombus formation and embolic events.
- To determine the utility of echocardiography in risk stratification.
Main Methods:
- Prospective study of 25 patients with nonischemic dilated cardiomyopathy.
- Serial two-dimensional echocardiograms performed over a mean follow-up of 21.5 months.
- Analysis of left ventricular thrombus incidence, resolution, and association with fractional shortening and embolic events.
Main Results:
- Left ventricular thrombus was present in 44% of patients initially and developed in others during follow-up.
- Thrombus was more frequent in patients with lower fractional shortening (≤10%).
- Five embolic events occurred, four associated with left ventricular thrombus; protruding thrombi had higher embolic risk.
Conclusions:
- Left ventricular thrombus and thromboembolism are frequent in nonanticoagulated dilated cardiomyopathy patients.
- Echocardiographic findings, particularly reduced fractional shortening and protruding thrombi, can predict embolic risk.
- Serial echocardiography is valuable for monitoring thrombus and guiding management.
Abstract:
To determine the prevalence and natural history of left ventricular thrombus in dilated cardiomyopathy, we prospectively performed two-dimensional echocardiograms in 25 patients with nonischemic dilated cardiomyopathy who were not receiving anticoagulation. Eighty-five echocardiograms were performed serially over a 9- to 30-month period (mean follow-up 21.5 months). A left ventricular thrombus was present on initial echocardiogram in 11 (44%) patients, became present during follow-up in an additional four, and disappeared in two. Thrombus was significantly more common in patients with fractional shortening of less than or equal to 10% (12 of 15) than in those with a fractional shortening 11% to 25% (3 of 10) (p less than 0.02). Five embolic events (four cerebral) occurred over the follow-up period, four of which were associated with a previously visualized left ventricular thrombus. Three of five thrombi that protruded into the left ventricular cavity subsequently embolized. We conclude that in nonanticoagulated patients with dilated cardiomyopathy left ventricular thrombus and thromboembolism are common. Echocardiography may be helpful in predicting which patients are at risk of thromboembolism.