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Risk factors and outcomes associated with Left Ventricular Thrombus in patients with Peripartum Cardiomyopathy: An
Kritika Luthra1, Sindhu R Avula2, Murugesan Raju3
1Mercy St. Vincent Medical Center, Toledo, OH, USA.
Insights
Peripartum cardiomyopathy (PPCM) patients with left ventricular thrombus (LVT) face increased risks of stroke and longer hospital stays. Aggressive risk factor modification is crucial for high-risk PPCM patients with LVT.
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Obstetrics
Background:
- Peripartum cardiomyopathy (PPCM) is a rare form of heart failure.
- Left ventricular thrombus (LVT) is a potential complication of PPCM.
- The prevalence and impact of LVT in PPCM patients require further investigation.
Purpose of the Study:
- To determine the prevalence of left ventricular thrombus (LVT) in patients diagnosed with peripartum cardiomyopathy (PPCM).
- To evaluate the impact of LVT on clinical outcomes and hospital resource utilization in PPCM patients.
Main Methods:
- A retrospective cohort study utilizing the Nationwide Inpatient Sample database (2005-2014).
- Analysis included admissions with PPCM as the primary diagnosis.
- Univariate and multivariable logistic regression analyses were performed to assess risk factors and outcomes.
Main Results:
- Over 43,000 PPCM admissions were identified, with 452 cases of LVT.
- Black race, smoking, drug abuse, and hypertension were associated with higher LVT incidence.
- LVT patients experienced longer hospital stays, higher hospitalization charges, and increased stroke rates, but not significantly different in-hospital mortality.
Conclusions:
- Left ventricular thrombus (LVT) is associated with poorer outcomes in peripartum cardiomyopathy (PPCM) patients, including increased stroke risk and prolonged hospitalization.
- Certain demographic and comorbidity profiles (e.g., Black race, diabetes with complications, coagulopathy) indicate higher LVT prevalence.
- Targeted risk factor modification is essential for high-risk PPCM patients with LVT to mitigate adverse events.
Background:
: We sought to assess the prevalence and impact of left ventricular thrombus (LVT) in patients with peripartum cardiomyopathy (PPCM).
Methods:
: We performed a retrospective cohort study of all admissions with PPCM as the primary diagnosis from the Nationwide Inpatient Sample database over a 11-year period. Univariate analysis of all risk factors and outcomes and multivariable logistic regression analysis of certain variables were performed and represented as odds ratio (OR) with 95% confidence interval (CI). A p value of < 0.05 was considered statistically significant. Statistical analysis was performed using epiDisplay in 'R' studio.
Results:
: In the time frame spanning 2005 -2014, 43,986 admissions with PPCM were found which included 43,534 without LVT and 452 patients with LVT. Black race was associated with a higher incidence of LV thrombus, (p value <0.001). Comorbidities more prevalent in the LVT group were smoking, drug abuse, pregnancy induced hypertension, diabetes with complications, valvular heart disease, connective tissue disorders, coagulopathy, anemia and depression. Adverse outcomes such as congestive heart failure, arrhythmias and stroke were higher in LVT group. Conversely, Caucasian race, obesity, preeclampsia (p <0.005) were higher in those without LVT. Mean length of stay (9 vs 5 days, p <0.001), in hospital mortality (3.32% vs 1.41%, p = 0.001) and mean hospitalization charges ($85,390 vs $48,033) were higher in those with LVT. However, on multivariate logistic regression, although stroke was higher in the LVT group (adjusted OR 5.51, 95% CI, 2.2, 13.81, 5.05, p 0.002), in-hospital mortality was not significantly different between the two groups (adjusted OR 1.17, 95% CI,0.32, 4.23, p = 0.817).
Conclusion:
: Our study showed that PPCM patients with LV thrombus had worse outcomes with respect to stroke, length of stay and in hospital mortality. Higher prevalence in patients with black race, complicated diabetes, peripheral vascular disease, valvular disease, coagulopathy, smoking, drug abuse, depression and psychoses calls for special attention to such high-risk groups for aggressive risk factor modification.
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