Left ventricular thrombus ups risk of MACE, death

Patients with left ventricular thrombus (LVT) are at increased risk of major adverse cardiovascular events (MACE) and mortality, while those with total LVT regression, achieved through various anticoagulant regimens, have a lower mortality, according to a study.

Of the 159 patients with a confirmed LVT, 48.4 percent were treated with vitamin K antagonists, 27.7 percent with parenteral heparins and 22.6 percent with direct oral anticoagulants. Antiplatelet therapy was administered to 67.9 percent of the population.

Majority of the patients (n=121; 76.1 percent) showed a reduction in the LVT area from baseline, and more than half (n=99; 62.3 percent) had total LVT regression within a median time of 103 days (interquartile range [IQR], 32–392 days).

Nonischaemic cardiomyopathy (hazard ratio [HR], 2.74, 95 percent confidence interval [CI], 1.43–5.26; p=0.002) and a smaller baseline thrombus area (HR, 0.66, 95 percent CI, 0.45–0.96; p=0.031) were independently associated with LVT regression.

During a median follow-up of 632 days (IQR, 187–1,126 days), MACE incidence was 37.1 percent, mortality 18.9 percent, stroke 13.3 percent, and major bleeding 13.2 percent. MACE occurred in 35.4 percent of patients with total LVT regression and in 40.0 percent of those with persistent LVT (p=0.203).

Patients with total LVT regression had a reduced mortality risk (HR, 0.48, 95 percent CI, 0.23–0.98; p=0.039), but those with persistent LVT showed a higher risk of major bleeding (9.1 percent vs 12 percent; HR, 0.34, 95 percent CI, 0.14–0.82; p=0.011).

Moreover, a left ventricular ejection fraction ≥35 percent (HR, 0.46, 95 percent CI, 0.23–0.93; p=0.029) and anticoagulation therapy >3 months (HR, 0.42, 95 percent CI, 0.20–0.88; p=0.021) independently correlated with fewer MACE.

In this study, the authors conducted a comprehensive computerized search of LVT using 90,065 consecutive echocardiogram reports from January 2011 to January 2018. Two independent experts performed imaging review to identify patients with a confirmed LVT.

MACE, which included death, stroke, myocardial infarction or acute peripheral artery emboli, as well as major bleeding events and all-cause mortality rates were determined.