Presence of Intracardiac Thrombus at the Time of Left Ventricular Assist Device Implantation Is Associated With an Increased Risk of Stroke and Death

Claudio A. Bravo; Justin A. Fried; Joshua Z. Willey; Azka Javaid; Giulio M. Mondellini; Lorenzo Braghieri; Heidi Lumish; Veli K. Topkara; Yuji Kaku; Lucas Witer; Hiroo Takayama; Koji Takeda; Gabriel Sayer; Nir Uriel; Ryan T. Demmer; Yoshifumi Naka; Melana Yuzefpolskaya; Paolo C. Colombo

doi:10.1016/j.cardfail.2021.06.011

Presence of Intracardiac Thrombus at the Time of Left Ventricular Assist Device Implantation Is Associated With an Increased Risk of Stroke and Death

Claudio A. Bravo
, Justin A. Fried
, Joshua Z. Willey
, Azka Javaid
, Giulio M. Mondellini
, Lorenzo Braghieri
, Heidi Lumish
, Veli K. Topkara
, Yuji Kaku
, Lucas Witer
, Hiroo Takayama
, Koji Takeda
, Gabriel Sayer
, Nir Uriel
, Ryan T. Demmer
, Yoshifumi Naka
, Melana Yuzefpolskaya
, Paolo C. Colombo

Epidemiology & Community Health

Research output: Contribution to journal › Article › peer-review

10 Scopus citations

Abstract

Background: Heart failure predisposes to intracardiac thrombus (ICT) formation. There are limited data on the prevalence and impact of preexisting ICT on postoperative outcomes in left ventricular assist device patients. We examined the risk for stroke and death in this patient population. Methods and Results: We retrospectively studied patients who were implanted with HeartMate (HM) II or HM3 between February 2009 and March 2019. Preoperative transthoracic echocardiograms, intraoperative transesophageal echocardiograms and operative reports were reviewed to identify ICT. There were 525 patients with a left ventricular assist device (median age 60.6 years, 81.8% male, 372 HMII and 151 HM3) included in this analysis. An ICT was identified in 44 patients (8.4%). During the follow-up, 43 patients experienced a stroke and 55 died. After multivariable adjustment, presence of ICT increased the risk for the composite of stroke or death at 6-month (hazard ratio [HR] 1.82, 95% confidence interval [CI] 1.00–3.33, P = .049). Patients with ICT were also at higher risk for stroke (HR 2.45, 95% CI 1.14–5.28, P = .021) and death (HR 2.36, 95% CI 1.17–4.79 P = .016) at 6 months of follow-up. Conclusions: The presence of ICT is an independent predictor of stroke and death at 6 months after left ventricular assist device implantation. Additional studies are needed to help risk stratify and optimize the perioperative management of this patient population.

Original language	English (US)
Pages (from-to)	1367-1373
Number of pages	7
Journal	Journal of cardiac failure
Volume	27
Issue number	12
Early online date	Jun 20 2021
DOIs	https://doi.org/10.1016/j.cardfail.2021.06.011
State	Published - Dec 2021

Bibliographical note

Funding Information:
Dr Colombo is the recipient of a research grant from Abbott; he also serves as a consultant for Abbott. Dr Naka serves as a consultant for Abbott, CryoLife, and Zimmer-Biomet, and as a speaker for Nipro Co. Dr Sayer serves as a consultant for Abbott. Dr Uriel serves on advisory boards for Leviticus and Livemetric/Cormetric; he also serves as a consultant for Abbott and Medtronic. The other authors report no conflicts.

Funding Information:
Supported by funds from the Lisa and Mark Schwartz Program to Reverse Heart Failure at New York-Presbyterian Hospital/Columbia University .

Publisher Copyright:
© 2021 Elsevier Inc.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Heart failure
assist device
intracardiac thrombus
left ventricular

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10.1016/j.cardfail.2021.06.011

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Bravo, C. A., Fried, J. A., Willey, J. Z., Javaid, A., Mondellini, G. M., Braghieri, L., Lumish, H., Topkara, V. K., Kaku, Y., Witer, L., Takayama, H., Takeda, K., Sayer, G., Uriel, N., Demmer, R. T., Naka, Y., Yuzefpolskaya, M., & Colombo, P. C. (2021). Presence of Intracardiac Thrombus at the Time of Left Ventricular Assist Device Implantation Is Associated With an Increased Risk of Stroke and Death. Journal of cardiac failure, 27(12), 1367-1373. https://doi.org/10.1016/j.cardfail.2021.06.011

Bravo, CA, Fried, JA, Willey, JZ, Javaid, A, Mondellini, GM, Braghieri, L, Lumish, H, Topkara, VK, Kaku, Y, Witer, L, Takayama, H, Takeda, K, Sayer, G, Uriel, N, Demmer, RT, Naka, Y, Yuzefpolskaya, M & Colombo, PC 2021, 'Presence of Intracardiac Thrombus at the Time of Left Ventricular Assist Device Implantation Is Associated With an Increased Risk of Stroke and Death', Journal of cardiac failure, vol. 27, no. 12, pp. 1367-1373. https://doi.org/10.1016/j.cardfail.2021.06.011

@article{5cec75961660421cbf439ec74b441155,

title = "Presence of Intracardiac Thrombus at the Time of Left Ventricular Assist Device Implantation Is Associated With an Increased Risk of Stroke and Death",

abstract = "Background: Heart failure predisposes to intracardiac thrombus (ICT) formation. There are limited data on the prevalence and impact of preexisting ICT on postoperative outcomes in left ventricular assist device patients. We examined the risk for stroke and death in this patient population. Methods and Results: We retrospectively studied patients who were implanted with HeartMate (HM) II or HM3 between February 2009 and March 2019. Preoperative transthoracic echocardiograms, intraoperative transesophageal echocardiograms and operative reports were reviewed to identify ICT. There were 525 patients with a left ventricular assist device (median age 60.6 years, 81.8\% male, 372 HMII and 151 HM3) included in this analysis. An ICT was identified in 44 patients (8.4\%). During the follow-up, 43 patients experienced a stroke and 55 died. After multivariable adjustment, presence of ICT increased the risk for the composite of stroke or death at 6-month (hazard ratio [HR] 1.82, 95\% confidence interval [CI] 1.00{\textendash}3.33, P = .049). Patients with ICT were also at higher risk for stroke (HR 2.45, 95\% CI 1.14{\textendash}5.28, P = .021) and death (HR 2.36, 95\% CI 1.17{\textendash}4.79 P = .016) at 6 months of follow-up. Conclusions: The presence of ICT is an independent predictor of stroke and death at 6 months after left ventricular assist device implantation. Additional studies are needed to help risk stratify and optimize the perioperative management of this patient population.",

keywords = "Heart failure, assist device, intracardiac thrombus, left ventricular",

author = "Bravo, \{Claudio A.\} and Fried, \{Justin A.\} and Willey, \{Joshua Z.\} and Azka Javaid and Mondellini, \{Giulio M.\} and Lorenzo Braghieri and Heidi Lumish and Topkara, \{Veli K.\} and Yuji Kaku and Lucas Witer and Hiroo Takayama and Koji Takeda and Gabriel Sayer and Nir Uriel and Demmer, \{Ryan T.\} and Yoshifumi Naka and Melana Yuzefpolskaya and Colombo, \{Paolo C.\}",

note = "Funding Information: Dr Colombo is the recipient of a research grant from Abbott; he also serves as a consultant for Abbott. Dr Naka serves as a consultant for Abbott, CryoLife, and Zimmer-Biomet, and as a speaker for Nipro Co. Dr Sayer serves as a consultant for Abbott. Dr Uriel serves on advisory boards for Leviticus and Livemetric/Cormetric; he also serves as a consultant for Abbott and Medtronic. The other authors report no conflicts. Funding Information: Supported by funds from the Lisa and Mark Schwartz Program to Reverse Heart Failure at New York-Presbyterian Hospital/Columbia University . Publisher Copyright: {\textcopyright} 2021 Elsevier Inc.",

year = "2021",

month = dec,

doi = "10.1016/j.cardfail.2021.06.011",

language = "English (US)",

volume = "27",

pages = "1367--1373",

journal = "Journal of cardiac failure",

issn = "1071-9164",

publisher = "Elsevier B.V.",

number = "12",

}

TY - JOUR

T1 - Presence of Intracardiac Thrombus at the Time of Left Ventricular Assist Device Implantation Is Associated With an Increased Risk of Stroke and Death

AU - Bravo, Claudio A.

AU - Fried, Justin A.

AU - Willey, Joshua Z.

AU - Javaid, Azka

AU - Mondellini, Giulio M.

AU - Braghieri, Lorenzo

AU - Lumish, Heidi

AU - Topkara, Veli K.

AU - Kaku, Yuji

AU - Witer, Lucas

AU - Takayama, Hiroo

AU - Takeda, Koji

AU - Sayer, Gabriel

AU - Uriel, Nir

AU - Demmer, Ryan T.

AU - Naka, Yoshifumi

AU - Yuzefpolskaya, Melana

AU - Colombo, Paolo C.

N1 - Funding Information: Dr Colombo is the recipient of a research grant from Abbott; he also serves as a consultant for Abbott. Dr Naka serves as a consultant for Abbott, CryoLife, and Zimmer-Biomet, and as a speaker for Nipro Co. Dr Sayer serves as a consultant for Abbott. Dr Uriel serves on advisory boards for Leviticus and Livemetric/Cormetric; he also serves as a consultant for Abbott and Medtronic. The other authors report no conflicts. Funding Information: Supported by funds from the Lisa and Mark Schwartz Program to Reverse Heart Failure at New York-Presbyterian Hospital/Columbia University . Publisher Copyright: © 2021 Elsevier Inc.

PY - 2021/12

Y1 - 2021/12

N2 - Background: Heart failure predisposes to intracardiac thrombus (ICT) formation. There are limited data on the prevalence and impact of preexisting ICT on postoperative outcomes in left ventricular assist device patients. We examined the risk for stroke and death in this patient population. Methods and Results: We retrospectively studied patients who were implanted with HeartMate (HM) II or HM3 between February 2009 and March 2019. Preoperative transthoracic echocardiograms, intraoperative transesophageal echocardiograms and operative reports were reviewed to identify ICT. There were 525 patients with a left ventricular assist device (median age 60.6 years, 81.8% male, 372 HMII and 151 HM3) included in this analysis. An ICT was identified in 44 patients (8.4%). During the follow-up, 43 patients experienced a stroke and 55 died. After multivariable adjustment, presence of ICT increased the risk for the composite of stroke or death at 6-month (hazard ratio [HR] 1.82, 95% confidence interval [CI] 1.00–3.33, P = .049). Patients with ICT were also at higher risk for stroke (HR 2.45, 95% CI 1.14–5.28, P = .021) and death (HR 2.36, 95% CI 1.17–4.79 P = .016) at 6 months of follow-up. Conclusions: The presence of ICT is an independent predictor of stroke and death at 6 months after left ventricular assist device implantation. Additional studies are needed to help risk stratify and optimize the perioperative management of this patient population.

AB - Background: Heart failure predisposes to intracardiac thrombus (ICT) formation. There are limited data on the prevalence and impact of preexisting ICT on postoperative outcomes in left ventricular assist device patients. We examined the risk for stroke and death in this patient population. Methods and Results: We retrospectively studied patients who were implanted with HeartMate (HM) II or HM3 between February 2009 and March 2019. Preoperative transthoracic echocardiograms, intraoperative transesophageal echocardiograms and operative reports were reviewed to identify ICT. There were 525 patients with a left ventricular assist device (median age 60.6 years, 81.8% male, 372 HMII and 151 HM3) included in this analysis. An ICT was identified in 44 patients (8.4%). During the follow-up, 43 patients experienced a stroke and 55 died. After multivariable adjustment, presence of ICT increased the risk for the composite of stroke or death at 6-month (hazard ratio [HR] 1.82, 95% confidence interval [CI] 1.00–3.33, P = .049). Patients with ICT were also at higher risk for stroke (HR 2.45, 95% CI 1.14–5.28, P = .021) and death (HR 2.36, 95% CI 1.17–4.79 P = .016) at 6 months of follow-up. Conclusions: The presence of ICT is an independent predictor of stroke and death at 6 months after left ventricular assist device implantation. Additional studies are needed to help risk stratify and optimize the perioperative management of this patient population.

KW - Heart failure

KW - assist device

KW - intracardiac thrombus

KW - left ventricular

UR - https://www.scopus.com/pages/publications/85111564192

UR - https://www.scopus.com/pages/publications/85111564192#tab=citedBy

U2 - 10.1016/j.cardfail.2021.06.011

DO - 10.1016/j.cardfail.2021.06.011

M3 - Article

C2 - 34161806

AN - SCOPUS:85111564192

SN - 1071-9164

VL - 27

SP - 1367

EP - 1373

JO - Journal of cardiac failure

JF - Journal of cardiac failure

IS - 12

ER -

Presence of Intracardiac Thrombus at the Time of Left Ventricular Assist Device Implantation Is Associated With an Increased Risk of Stroke and Death

Abstract

Bibliographical note

UN SDGs

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