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Updated: Jun 13, 2025
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Resolution of left ventricular thrombus assessed by echocardiography: insights from a contemporary multicentre
Andrea Barbieri1, Francesca Bursi2, Francesca Mantovani3
1Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo, 71, 41125 Modena, Italy.
Insights
Left ventricular thrombus (LVT) resolution was achieved in 68% of patients, significantly reducing risks of embolic events and death. Echocardiographic predictors of LVT persistence were identified, informing personalized follow-up strategies.
Area of Science:
- Cardiology
- Echocardiography
- Thrombosis
Background:
- Detecting and monitoring left ventricular thrombus (LVT) is challenging due to limited retrospective, single-center data.
- Current understanding of LVT resolution and its long-term implications is incomplete.
Purpose of the Study:
- To determine the incidence and predictors of LVT resolution using echocardiography.
- To evaluate the clinical implications of LVT resolution on long-term outcomes in a contemporary patient cohort.
Main Methods:
- A prospective, multicenter observational study involving ten centers.
- Echocardiographic follow-up was conducted at multiple time points post-LVT detection.
- Clinical endpoints included mortality, embolic complications, and bleeding events.
Main Results:
- LVT resolution occurred in 68% of 154 patients within a median follow-up of 36 days.
- Smaller LVT area and mobile LVT at baseline, and improved LV function at follow-up, predicted resolution.
- LVT resolution was associated with significantly lower risks of embolic events and death (adjusted HR 0.36 for both).
Conclusions:
- Left ventricular thrombus (LVT) persists in approximately one-third of patients despite anticoagulation, correlating with poorer prognosis.
- Echocardiographic predictors of LVT persistence can guide personalized follow-up and treatment strategies.
- LVT resolution is linked to improved long-term outcomes without an increased risk of bleeding complications.
Aims:
How to detect and monitor left ventricular thrombus (LVT) remains complex since clinicians can rely only on retrospective, single-centre data. To characterize the incidence and independent associates of LVT resolution (assessed with echocardiography) and its clinical implications on long-term follow-up in a contemporary cohort of consecutive patients with LVT.
Methods And Results:
Ten centres were involved in this observational prospective multicentre study. The use of different anti-thrombotic regimens and ultrasound contrast was left at the discretion of attending physicians. Echocardiographic follow-up was performed on days 16 ± 8, 48 ± 13, and 132 ± 99 days from LVT detection. Resolution was defined as a complete disappearance of LVT on all echocardiographic views at the last available follow-up. Clinical endpoints included all-cause mortality, embolic complications, and bleeding events. From October 2020 to September 2022, 154 consecutive patients with LVT (mean age 67 ± 11 years, 79% men) were enrolled. Different anti-coagulant regimens were used, and the median duration of anti-coagulation was 6 (3-12) months. LVT resolution was achieved in 68% at a median follow-up of 36 (IQR 15-74) days. At baseline assessment, LVT characteristics like smaller LVT area and mobile LVT were independent predictors of LVT resolution. At follow-up echocardiogram, greater LV global and apical mechanical function were independently associated with LVT resolution (OR, 1.04, 95% CI 1.01-1.07, P = 0.026 for LVEF and 0.94, 95% CI 0.89-0.99, P = 0.025 for apical wall motion score index). During a median follow-up of 1.91 (IQR, 1.32-2.83) years, patients with LVT resolution showed a significantly lower risk of embolic events (adjusted HR, 0.36 95% CI 0.13-0.99, P = 0.04) and death (adjusted HR, 0.36 95% CI 0.14-0.95, P = 0.03) compared with those without resolution. Moreover, LVT resolution was not associated with bleeding complications.
Conclusion:
The present longitudinal multicentre registry reveals that LVT persists in nearly one-third of patients after initial detection, even with anti-coagulation therapy, and is associated with a poorer prognosis. Additionally, it offers valuable insights into echocardiographic predictors of LVT persistence, which could inform personalized follow-up strategies and treatment approaches.
