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Comparison of embolic risk in left ventricular thrombus between nonischemic and ischemic cardiomyopathy: A nationwide
Masashi Fujino1, Hirohiko Aikawa2, Kazuhiro Nakao2
1Department of Cardiovascular Medicine, National Cerebral and Cardiovascular (NCVC) Center, Osaka, Japan; Victorian Heart Institute, Monash University, Melbourne, Australia.
Insights
Patients with left ventricular (LV) thrombus face embolic risks. While ischemic cardiomyopathy (ICM) and nonischemic cardiomyopathy (NICM) show similar overall risks, dilated cardiomyopathy (DCM) within NICM presents a significantly higher risk of systemic embolism.
Area of Science:
- Cardiology
- Vascular Medicine
- Thrombosis Research
Background:
- Left ventricular (LV) thrombus formation carries a substantial risk of embolic stroke and systemic embolism.
- The comparative embolic risk between nonischemic cardiomyopathy (NICM) and ischemic cardiomyopathy (ICM) in LV thrombus patients is not well-defined.
Purpose of the Study:
- To investigate and compare the incidence of embolic stroke or systemic embolism (SSE) in patients with LV thrombus due to ICM versus NICM.
- To identify specific subtypes of NICM that may confer a higher risk of SSE.
Main Methods:
- Analysis of 1037 patients with LV thrombus from the Japanese Registry of All Cardiac and Vascular Diseases Diagnosis Procedure Combination (JROAD-DPC) database.
- Patients were categorized into ICM (826) and NICM (211) groups.
- Comparison of the primary outcome (SSE during hospitalization) between ICM and NICM groups, with further analysis of SSE rates within NICM subtypes (dilated cardiomyopathy [DCM], takotsubo cardiomyopathy, hypertrophic cardiomyopathy).
Main Results:
- Overall SSE rates were comparable between ICM (5.8%) and NICM (7.6%) groups (p=0.34).
- Within the NICM group, SSE occurred in 12.6% of DCM patients, 7.0% of takotsubo cardiomyopathy patients, and 2.6% of hypertrophic cardiomyopathy patients.
- Multivariate analysis indicated that DCM posed a significantly higher adjusted risk of SSE compared to ICM (OR 2.6; 95% CI, 1.2-6.0; p=0.022).
Conclusions:
- This study demonstrates similar embolic event rates between ICM and NICM patients with LV thrombus.
- Dilated cardiomyopathy (DCM) is identified as a significant risk factor for SSE in NICM patients with LV thrombus.
- Clinical management strategies for LV thrombus should consider the specific etiology of cardiomyopathy, particularly DCM, due to its elevated embolic risk.
Background:
Left ventricular (LV) thrombus is not common but poses significant risks of embolic stroke or systemic embolism. However, the distinction in embolic risk between nonischemic cardiomyopathy (NICM) and ischemic cardiomyopathy (ICM) remains unclear.
Methods And Results:
In total, 2738 LV thrombus patients from the JROAD-DPC (Japanese Registry of All Cardiac and Vascular Diseases Diagnosis Procedure Combination) database were included. Among these patients, 1037 patients were analyzed, with 826 (79.7%) having ICM and 211 with NICM (20.3%). Within the NICM group, the distribution was as follows: dilated cardiomyopathy (DCM; 41.2%), takotsubo cardiomyopathy (27.0%), hypertrophic cardiomyopathy (18.0%), and other causes (13.8%). The primary outcome was a composite of embolic stroke or systemic embolism (SSE) during hospitalization. The ICM and NICM groups showed no significant difference in the primary outcome (5.8% vs. 7.6%, p = 0.34). Among NICM, SSE occurred in 12.6% of patients with DCM, 7.0% with takotsubo cardiomyopathy, and 2.6% with hypertrophic cardiomyopathy. Multivariate logistic regression analysis for SSE revealed an odds ratio of 1.4 (95% confidence interval [CI], 0.7-2.7, p = 0.37) for NICM compared to ICM. However, DCM exhibited a higher adjusted odds ratio for SSE compared to ICM (2.6, 95% CI 1.2-6.0, p = 0.022).
Conclusions:
This nationwide shows comparable rates of embolic events between ICM and NICM in LV thrombus patients, with DCM posing a greater risk of SSE than ICM. The findings emphasize the importance of assessing the specific cause of heart disease in NICM, within LV thrombus management strategies.
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