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Clinical Investigations: CARDIOLOGY |

Left Ventricular Thrombus and Subsequent Thromboembolism in Patients With Severe Systolic Dysfunction*

Nagaraja D. Sharma, MD; Peter A. McCullough, MD, MPH; Edward F. Philbin, MD; W. Douglas Weaver, MD
Author and Funding Information

*From the Henry Ford Heart and Vascular Institute, Henry Ford Health System, Detroit, MI.

Correspondence to: Peter A. McCullough, MD, MPH, Henry Ford Health System, Henry Ford Heart and Vascular Institute, 6525 Second Ave, Detroit, MI 48202; e-mail: pmc@mich.com



Chest. 2000;117(2):314-320. doi:10.1378/chest.117.2.314
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Study objectives: To determine the frequency of left ventricular (LV) thrombi by echocardiography and to define the predictors of LV thrombus and subsequent thromboembolism.

Design: Retrospective case-control design.

Setting: Single tertiary care center.

Patients: Twenty-eight patients with LV thrombus in a consecutive series of 144 patients with severe LV dysfunction and follow-up period for a mean of 27.6 months.

Measurements and results: Thirty-five clinical and echocardiographic variables were evaluated. The mean age of patients with (n = 28) vs patients without (n = 116) LV thrombus was 50.3 ± 11.0 years vs 54.2 ± 11.1 years (p = 0.09), with 22 patients (78.6%) and 78 patients (67.2%) being male (p = 0.24), respectively. The mean ejection fraction (EF) for those with vs those without LV thrombus was 17.5 ± 5.5 vs 20.0 ± 6.9 (p = 0.08), with 16 patients (57.1%) and 42 patients (36.2%) having an EF < 20% (p = 0.04), respectively. The groups were similar with respect to other baseline characteristics, comorbid illnesses, and drug therapies other than anticoagulants. All 28 patients with LV thrombus (100%) and 54 of those without LV thrombus (46.6%) were treated with warfarin. Ischemic etiology of the cardiomyopathy (odds ratio, 4.78; 95% confidence interval, 1.51 to 15.11; p = 0.008) and increased LV internal diastolic dimension (LVIDD; odds ratio, 1.10; 95% confidence interval, 1.03 to 1.18; p = 0.004) were found to be independent predictors of thrombus formation. Peripheral embolism occurred in 5 patients (17.9%) vs 13 patients (11.2%) of those with and without LV thrombi, respectively (p = 0.35). Ischemic etiology of the cardiomyopathy (odds ratio, 3.79; 95% confidence interval, 1.13 to 12.64; p = 0.03) and EF (odds ratio, 0.91; 95% confidence interval, 0.82 to 1.00; p = 0.04) were found to be independent predictors of systemic embolization. The patients with an embolic event suffered a significantly higher mortality (7 of 18 patients; 38.9%) during the follow-up period when compared to those without an embolic event (13 of 126 patients; 10.3%; p < 0.0001).

Conclusions: We conclude that ischemic cardiomyopathy and dilated LV chamber sizes (LVIDD > 60 mm) are independently associated with LV thrombi. A peripheral embolic event is related to poor long-term survival in this patient group.

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