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.
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.