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Cardiac thrombus in dilated cardiomyopathy. Relationship between left ventricular pathophysiology and left
Y Yokota1, H Kawanishi, M Hayakawa
1First Department of Internal Medicine, Kobe University School of Medicine, Japan.
Insights
Left ventricular thrombus in dilated cardiomyopathy (DCM) is linked to abnormal heart wall motion and blood flow. Anticoagulant therapy, like warfarin, helps prevent embolism and thrombus formation in DCM patients.
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Medical Imaging
Background:
- Dilated cardiomyopathy (DCM) is associated with an increased risk of left ventricular thrombus formation.
- Understanding the relationship between left ventricular dynamics and thrombus in DCM is crucial for patient management.
Purpose of the Study:
- To investigate the association between left ventricular dynamics and the occurrence of left ventricular thrombus in patients with dilated cardiomyopathy.
- To evaluate the role of anticoagulant therapy in preventing thromboembolic events and intracardiac thrombus in DCM.
Main Methods:
- Echocardiography (2D and pulsed Doppler) and postmortem examination were used in 57 DCM patients.
- Analysis included assessment of left ventricular segmental wall motion abnormalities and Doppler ejection flow patterns.
- Patient data on systemic/pulmonary embolism and intracardiac thrombus, with and without warfarin treatment, were analyzed.
Main Results:
- Left ventricular thrombus was more frequent in patients with apical dyskinesis/akinesis.
- Abnormal Doppler ejection flow signals were observed, particularly at the apex and middle portions of the left ventricle.
- Warfarin treatment was associated with a lower incidence of embolism and intracardiac thrombus.
Conclusions:
- Endomyocardial and blood flow disorders significantly contribute to left ventricular thrombus formation in DCM.
- Anticoagulant therapy demonstrates efficacy in preventing thromboembolic complications and intracardiac thrombus in DCM patients.
Abstract:
The relationship between left ventricular thrombus and left ventricular dynamics in dilated cardiomyopathy (DCM) was studied by echocardiography and postmortem examination. The subjects were 57 patients with DCM, 40 were survival patients examined by echocardiography and 17 were autopsy patients. Systemic or pulmonary embolism occurred in 10 of 57 patients, 4 of 40 survival patients and 6 of 17 autopsy patients. Intracardiac thrombus was detected in 11 of 40 survival patients and was found in 8 of 17 autopsy patients. Left ventricular segmental wall motion abnormalities were observed in all 40 patients examined by two-dimensional echocardiography and apical dyskinesis or akinesis was observed more frequently in patients with left ventricular thrombus than in patients without left ventricular thrombus. Of 33 patients examined by pulsed Doppler echocardiography, Doppler ejection flow signals in the apical long axis view were recorded in 9% at the apex, in 17% at the middle portion and in 57% at the portion near the interventricular septal center. The signals at the portion near the interventricular septal center were recorded in only 2 patients with left ventricular thrombus but in 66% of patients without left ventricular thrombus. Systemic or pulmonary embolism and intracardiac thrombus occurred less frequently in patients treated with warfarin than in patients without warfarin. These results indicate that endomyocardial and blood flow disorders of the left ventricle play important roles in the occurrence of left ventricular thrombus and that anticoagulant therapy is useful for the prevention of systemic or pulmonary embolism and cardiac thrombus.