Related Experiment Video
Updated: Jun 18, 2025
Cardiac Magnetic Resonance for the Evaluation of Suspected Cardiac Thrombus: Conventional and Emerging Techniques
Published on: June 11, 2019
Time Trends of Etiology, Treatment, and Long-Term Outcomes Among Patients with Left Ventricular Thrombus
Boqun Shi1,2,3, Yanjun Song1,2,3, Lie Ma1,2,3
1Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, 100037 Beijing, China.
Insights
Anticoagulant therapy did not improve prognosis for left ventricular thrombus (LVT) patients, primarily caused by heart failure. Further research is needed to optimize anticoagulation management for better outcomes in LVT patients.
Area of Science:
- Cardiology
- Cardiovascular Research
- Thrombosis Research
Background:
- Left ventricular thrombus (LVT) etiology has shifted, with heart failure becoming the primary cause, diverging from traditional STEMI guidelines.
- Current heart failure guidelines lack specific recommendations for LVT treatment due to limited evidence.
- This study reviews LVT etiology, antithrombotic therapy changes, and anticoagulation impact from a single center's experience.
Purpose of the Study:
- To investigate the clinical characteristics and outcomes of patients with left ventricular thrombus (LVT).
- To analyze the impact of anticoagulation therapy on LVT patient prognosis.
- To identify predictors of major adverse cardiac and cerebrovascular events (MACCE) in LVT patients.
Main Methods:
- A retrospective study of 1675 patients diagnosed with LVT between January 2009 and June 2021.
- Patients were categorized into anticoagulant and non-anticoagulant groups based on discharge therapy.
- Outcomes assessed included all-cause death, cardiovascular death, stroke, MACCE, systemic embolism, and major bleeding, analyzed using multivariable competing risk regression, matching, and weighting.
Main Results:
- Of 909 patients analyzed, 510 received anticoagulation. The anticoagulation group had higher rates of dilated cardiomyopathy and lower LVEF.
- Despite increased oral anticoagulation use over time, no significant difference in the six primary endpoints was found between groups.
- Diabetes, renal insufficiency, prior stroke, and HFrEF were identified as predictors of increased MACCE risk.
Conclusions:
- Heart failure is the predominant cause of LVT, necessitating updated treatment guidelines.
- Anticoagulant therapy did not demonstrate a significant improvement in prognosis for LVT patients in this cohort.
- Optimizing anticoagulation management strategies is crucial for improving patient outcomes in LVT.
Background:
Recommendations for drug treatment of left ventricular thrombus (LVT) are based on the ST-segment elevation myocardial infarction (STEMI) guidelines; however, the etiology of LVT has changed. Due to the lack of evidence regarding LVT treatment in the heart failure population, current heart failure guidelines do not cover LVT treatment. We sought to review the etiology of LVT and changes in antithrombotic therapy over the previous 12 years and explore the impact of anticoagulation treatment from a single center's experience.
Methods:
From January 2009 to June 2021, we studied 1675 patients with a discharge diagnosis of LVT at a single center to investigate the clinical characteristics, incidence of all-cause death, cardiovascular death, ischemic stroke, major adverse cardiac and cerebrovascular events (MACCE), systemic embolism (SE), and major bleeding events. Patients were divided into an anticoagulant group and a non-anticoagulant group according to whether they received oral anticoagulant therapy at discharge.
Results:
The study included 909 patients (anticoagulation, 510; no anticoagulation, 399). While overall antiplatelet therapy dramatically decreased, more patients with LVT received oral anticoagulation in 2021 (74.0%) than in 2009 (29.6%). In addition, more than half of the patients had heart failure with reduced ejection fraction (HFrEF) each year. The all-cause mortality was 17.3% during 3.8 years of follow-up. The incidences of cardiovascular death, stroke, MACCE, SE, and major bleeding were 16.0%, 3.3%, 19.8%, 5.1%, and 1.7%, respectively. The anticoagulation group had a significantly higher proportion of dilated cardiomyopathy than the non-anticoagulation group (24.7% vs. 5.5%, p 0.001), and a lower LVEF (34.0 vs. 41.0, p 0.001). The anticoagulation group also had a higher probability of adverse events on long-term follow-up (p 0.05). A multivariable competing risk regression model found no significant difference in all six endpoints between the groups (all p 0.05). Similar results were found by matched and weighted data analysis. Diabetes mellitus (hazard ratio (HR), 1.42; 95% confidence interval (CI), 1.04-1.93; p = 0.027), renal insufficiency (HR, 2.36; 95% CI, 1.60-3.50; p 0.001), history of previous stroke (HR, 1.60; 95% CI, 1.13-2.29; p = 0.009), and HFrEF (HR, 2.54; 95% CI, 1.78-3.64; p 0.001) were predictors of increased risk of MACCE.
Conclusions:
Heart failure, rather than acute myocardial infarction, is currently the primary cause of LVT. A trend towards better prognosis in the no anticoagulation group was noted. Multivariable, matching and weighting analysis showed no improvement in prognosis with anticoagulant therapy. Our study does not negate the efficacy of anticoagulation but suggests the need to strengthen the management of anticoagulation in order to achieve better efficacy.
