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Published on: June 11, 2019
A prediction model for left ventricular thrombus persistence/recurrence: based on a prospective study and a
Qing Yang1, Xin Quan1,2, Chuangshi Wang1,3
1National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China.
Insights
This study developed a prediction model to identify patients at high risk for persistent left ventricular (LV) thrombus. The model aids in determining optimal anticoagulation duration for LV thrombus patients.
Area of Science:
- Cardiology
- Medical Prediction Modeling
Background:
- Optimal anticoagulation duration for persistent left ventricular (LV) thrombus remains unclear.
- Identifying patients with unresolved thrombus is crucial for treatment decisions.
Purpose of the Study:
- To develop and validate a prediction model for forecasting thrombus persistence or recurrence in patients with LV thrombus.
- To identify clinical characteristics associated with unresolved LV thrombus.
Main Methods:
- Prospective and retrospective cohorts (2013-2022) combined for model derivation.
- Lasso and logistic regression used to select independent predictors.
- A nomogram risk prediction model was developed and applied for risk stratification.
Main Results:
- Six predictors were identified for the logistic regression model.
- Protuberant thrombus and higher D-dimer levels were associated with reduced persistence/recurrence risk.
- Thicker thrombus was linked to an increased rate of persistent thrombus.
Conclusions:
- The developed prediction model can forecast persistent/recurrent LV thrombus.
- The model identifies characteristics associated with unresolved thrombus.
- Prospective randomized trials are needed to validate the model and guide anticoagulation duration.
Background:
It remains unknown whether anticoagulation for persistent left ventricular (LV) thrombus should be continued indefinitely. Identifying patients with a high risk of thrombus unresolved may be helpful to determine the optimum anticoagulation duration. This study aimed to develop a prediction model to forecast thrombus persistence or recurrence in patients with LV thrombus.
Methods:
We enrolled patients prospectively from 2020 to 2022 and retrospectively from 2013 to 2019 at the National Center of Cardiovascular Diseases of China. The two cohorts were then combined to derive predictive models of thrombus persistence/recurrence. The primary study comprised patients who received systemic oral anticoagulants and had imaging records available at the end of a 3-month follow-up period. The Lasso regression algorithm and the logistic regression were performed to select independent predictors. The calibration curve was generated and a nomogram risk prediction model was applied as a risk stratification tool.
Results:
A total of 172 (64 in the prospective cohort and 108 in the retrospective cohort) patients were included, with 124 patients in a training set and 48 patients in a validation set. Six predictors were incorporated into the multivariate logistic regression prediction model. The area under the receiving operating characteristic was 0.852 in the training set and 0.631 in the validation set. Patients with protuberant thrombus and higher baseline D-dimer levels had a reduced risk of persistence/recurrence (OR 0.17, 95% CI 0.03-0.69, P = 0.025; OR 0.67, 95% CI 0.43-0.91, P = 0.030, separately), whereas thicker thrombus was linked to an increased rate of persistent thrombus (OR 1.11, 95% CI 1.05-1.20, P = 0.002). Additionally, patients with diverse diagnoses or receiving different antiplatelet treatments had different rates of LV thrombus persistence/recurrence at 3 months.
Conclusions:
This prediction model provides tools to forecast the occurrence of persistent/recurrent thrombus and allows the identification of characteristics associated with unresolved thrombus. To validate the model and determine the duration of anticoagulation in patients with persistent thrombus, prospective randomized trials are necessary.
