Clinical Outcome After Left Ventricular Thrombus Resolution: Who Needs Long-Term or Lifetime Use of Anticoagulants?

Xiao Dong Zhou, Qin Fen Chen, Christos S. Katsouras, Prabhjot S. Nijjar, Kenneth I. Zheng, Haihui Zhu, Mengge Gong, Qingcheng Lin, Youkai Jin, Weijian Huang, Peiren Shan

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1 Scopus citations

Abstract

BACKGROUND: Patients with left ventricular thrombus (LVT) resolution can have LVT recurrence and risk for thromboembolism. However, these outcomes after LVT resolution are not well known. We aimed to assess the prevalence, risk factors, and clinical outcomes for LVT recurrence in patients with LVT resolution to inform follow-up and treatment. METHODS AND RESULTS: Patients with LVT resolution were identified retrospectively from a large echocardiography database between January 2009 and May 2022. Participants had echocardiograms at 3 time points, including baseline at LVT diag-nosis, at LVT resolution, and a follow-up for identification of LVT recurrence. The cumulative LVT recurrence rate was esti-mated by the Kaplan– Meier method, and predictors of LVT recurrence were evaluated using Cox regression analysis. Among 115 patients with LVT resolution, 28 (24.3%) had LVT recurrence at a median follow-up of 1.2 (0.5– 2.8) years. LV aneurysm (hazard ratio [HR], 2.59 [95% CI, 1.20– 5.58], P=0.015) and anticoagulant use (HR, 0.12 [95% CI, 0.04– 0.41], P=0.001) were predictors of LVT recurrence on multivariable analysis. Patients with an LV aneurysm who did not receive any anticoagulation demonstrated an LVT recurrence rate of 69.5%, whereas those without an LV aneurysm who received anticoagulation had a recurrence rate of 0%. Patients with LVT recurrence had a higher incidence of an embolic event (10.7% versus 1.1%, P=0.016). CONCLUSIONS: LVT recurrence after LVT resolution is common, especially in those with an LV aneurysm, and is associated with a higher embolic risk. Continued anticoagulation is protective against LVT recurrence, although bleeding risk needs to be considered. These findings can inform follow-up and treatment of patients with documented LVT resolution.

Original languageEnglish (US)
Article numbere029070
JournalJournal of the American Heart Association
Volume12
Issue number8
DOIs
StatePublished - Apr 18 2023

Bibliographical note

Funding Information:
This study was supported by the Medical Health Science and Technology Project of Zhejiang Province (2021RC091), National Natural Science Foundation of China (82270282), the Joint Funds of the Zhejiang Provincial Natural Science Foundation of China (LHDMY23H310001), and Wenzhou Science Technology Bureau Foundation (Y20220079, 2022Y0726).

Publisher Copyright:
© 2023 The Authors.

Keywords

  • anticoagulant
  • left ventricular aneurysm
  • left ventricular thrombus
  • recurrence
  • resolution

PubMed: MeSH publication types

  • Journal Article
  • Research Support, Non-U.S. Gov't

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