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Clinical and Echocardiographic Factors Associated With Left Ventricular Thrombus Recurrence
Kirsten M Lipps1, Hossam Elbenawi2, Samuel Heller3
1Division of Vascular Medicine, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
JACC. Advances
|June 17, 2026
Summary
Left ventricular thrombus (LVT) recurrence affects oral anticoagulation decisions. Recurrence was linked to LV apical aneurysm and prior stroke, while higher LV ejection fraction and continued OAC reduced risk.
Area of Science:
- Cardiology
- Echocardiography
- Thrombosis Research
Background:
- Left ventricular thrombus (LVT) recurrence risk is crucial for determining oral anticoagulation (OAC) therapy duration.
- Understanding factors influencing LVT recurrence is essential for patient management.
Purpose of the Study:
- To assess the risk of LVT recurrence in patients with resolved LVT.
- To identify clinical and echocardiographic factors associated with LVT recurrence.
Main Methods:
- A multicenter, retrospective cohort study of patients with resolved LVT diagnosed via echocardiography.
- Evaluation of clinical and echocardiographic data at LVT diagnosis and resolution.
- Multivariable Cox proportional hazards regression to determine recurrence predictors.
Main Results:
- LVT recurred in 14.3% of 252 patients.
- Recurrent LVT was associated with lower LV ejection fraction (LVEF) and LV apical aneurysm at resolution.
- Continued OAC post-resolution significantly reduced recurrence rates (54.7% vs 25.0%).
- Independent predictors of recurrence included LV apical aneurysm and prior ischemic stroke.
- Higher LVEF and OAC continuation were protective against recurrence.
Conclusions:
- LVT recurrence occurred in 14% of patients, influenced by echocardiographic findings at resolution.
- LV apical aneurysm and prior stroke increased recurrence risk.
- Higher LVEF and continued OAC were associated with decreased LVT recurrence, guiding OAC duration decisions.
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