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Factors influencing left ventricular thrombus resolution and its significance on clinical outcomes

Se-Eun Kim1, Chan Joo Lee1, Jaewon Oh1

  • 1Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.

ESC Heart Failure
|April 3, 2023
PubMed

Insights

Left ventricular thrombus (LVT) resolution is linked to better clinical outcomes in patients with reduced ejection fraction. Failure of left ventricular ejection fraction (LVEF) improvement hinders LVT resolution and increases recurrence risk.

Area of Science:

  • Cardiology
  • Internal Medicine

Background:

  • Left ventricular thrombus (LVT) is a common complication in patients with impaired left ventricular systolic function.
  • Established treatment strategies for LVT are lacking, necessitating research into factors influencing its resolution and clinical impact.

Purpose of the Study:

  • To identify factors associated with LVT resolution.
  • To determine the clinical significance of LVT resolution on patient outcomes.
  • To investigate predictors of LVT recurrence after resolution.

Main Methods:

  • Retrospective analysis of 212 patients with LVT and left ventricular ejection fraction (LVEF) < 50% from January 2010 to July 2021.
  • LVT resolution monitored via serial echocardiography.
  • Primary outcome: composite of all-cause death, stroke, transient ischemic attack, and arterial thromboembolism; LVT recurrence also evaluated.

Main Results:

  • LVT resolution occurred in 84.4% of patients.
  • Failure of LVEF improvement within 6 months significantly hindered LVT resolution (HR: 0.52).
  • LVT resolution was independently associated with a lower risk of adverse clinical outcomes (HR: 0.45).
  • LVEF improvement failure at LVT resolution predicted higher recurrence risk (HR: 3.10).

Conclusions:

  • LVT resolution is a significant predictor of favorable clinical outcomes.
  • Impaired LVEF improvement is a key factor impeding LVT resolution and promoting recurrence.
  • Anticoagulation continuation post-resolution did not significantly impact recurrence or prognosis.
Abstract

Keywords:
AnticoagulationClinical outcomeLeft ventricular systolic functionLeft ventricular thrombusLeft ventricular thrombus recurrenceLeft ventricular thrombus resolution

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