The prevalence, predictors, and outcomes of spontaneous echocardiographic contrast or left ventricular thrombus in patients with HFrEF

Zhou, Xiaodong; Shi, Ruiyu; Wu, Gaojun; Zhu, Qing; Zhou, Changzuan; Wang, Liang‐Guo; Xue, Chenglong; Jiang, Yuanyuan; Cai, Xueli; Huang, Weijian; Shan, Peiren

doi:10.1002/ehf2.13196

Cited by 19 publications

(16 citation statements)

References 29 publications

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“…In the LV, clinical observation of echocardiographic "smoke" suggest RBC aggregates can form in this chamber [81,82] [84], and these features are exacerbated after acute myocardial infarction [13]. Thus, the existing data suggest that non-Newtonian effects in the LV should not be discarded altogether.…”

Section: Effects Of Non-newtonian Rheology On La and Laa Hemodynamics And Blood Residence Timementioning

confidence: 99%

“…4.3 Effects of non-Newtonian rheology on LA and LAA hemodynamics and blood residence timeThere is little information about the influence of blood's shear-thinning rheology on intracardiac hemodynamics.In the LV, clinical observation of echocardiographic "smoke" suggest RBC aggregates can form in this chamber[81,82], and two modeling studies have evaluated non-Newtonian effects. Doost et al used CFD analysis to evaluate various constitutive relations on a patient-specific LV anatomical model, finding that blood viscosity increased strongly in the apical region [77].…”

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confidence: 99%

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Non-Newtonian Blood Rheology Impacts Left Atrial Stasis in Patient-Specific Simulations

Gonzalo

García-Villalba

Rossini³

et al. 2021

Preprint

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Atrial fibrillation (AF) is the most common arrhythmia, affecting ~35M people worldwide. The irregular beating of the left atrial (LA) caused by AF impacts the LA hemodynamics increasing the risk of thrombosis and ischemic stroke. Most LA thrombi appear in its appendage (LAA), a narrow sac of varied morphology where blood is prone to stagnate. In the LAA, the combination of slow blood flow and low shear rates (<100 [1/s]) promotes the formation of red blood cell aggregations called rouleaux. Blood experiences a non-Newtonian behavior when rouleaux formed that has not been considered in previous CFD analysis of the LA. We model the anatomy and motion of the LA from 4D-CT images and solve the blood flow inside the LA geometry with our CFD in-house code, which models Non-Newtonian rheology with the shear-hematocrit-dependent Carreau-Yasuda equation. We cover a wide range of non-Newtonian effects considering a small and a large hematocrit, including an additional constitutive relation to account for themrouleaux formation time, and we compare our results with Newtonian simulations. Blood rheology influence in LAA hemostasis is studied in 6 patient-specific anatomies. Two subjects had an LAA thrombus (digitally removed before running the simulations), another had a history of TIAs, and the remaining three had normal atrial function. In our simulations, the shear rate remains below 50 [1/s] in the LAA for all non-Newtonian models considered. This triggers an increase of viscosity that alters the flow behavior in that site, which exhibits different flow patterns than Newtonian simulations. These hemodynamic changes translate into differences in the LAA hemostasis, calculated with the residence time.

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Section: Effects Of Non-newtonian Rheology On La and Laa Hemodynamics And Blood Residence Timementioning

confidence: 99%

mentioning

confidence: 99%

Non-Newtonian Blood Rheology Impacts Left Atrial Stasis in Patient-Specific Simulations

Gonzalo

García-Villalba

Rossini³

et al. 2021

Preprint

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“…LVT can also occur in patients with severe left ventricular systolic dysfunction due to non-ischemic cardiomyopathy [ 6 ]. The estimated prevalence of LVT in patients with severe systolic dysfunction ranges from 2.1% to 7.0%, compared to 7% to 22% following MI [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Rivaroxaban for Treatment of Left Ventricular Thrombus: A Case Report

et al. 2021

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Patient: Male, 43-year-old Final Diagnosis: Heart failure • HIV infection • thrombosis Symptoms: Heart failure Medication: — Clinical Procedure: Echocardiography Specialty: General and Internal Medicine Objective: Unusual clinical course Background: Left ventricular thrombus (LVT) is a complication of left ventricular dysfunction and myocardial infarction (MI) and is associated with systemic thromboembolism. Two-dimensional transthoracic echocardiography (TTE) is considered the first-line diagnostic tool for detection of LVT. Vitamin K antagonists (VKA) targeting an international normalized ratio (INR) from 2 to 3 are the only approved treatments by the Food and Drug Administration (FDA). New emerging observational data support the use of direct oral anticoagulants (DOACs) as an alternative therapeutic option; however, their safety and efficacy have not been assessed in a good-quality randomized controlled trial. Case Report: Here, we present a case of a 43-year-old man diagnosed with human immunodeficiency virus (HIV)-associated dilated cardiomyopathy complicated with an LVT. He was treated with rivaroxaban for 9 consecutive months with no interruption of therapy at any point in time; however, he presented to the emergency department with symptoms of decompensated heart failure. A follow-up TTE demonstrated a significant increase in the size of his LVT. This case questions the efficacy of using factor Xa inhibitor (rivaroxaban) as an alternative option for LVT treatment. Conclusions: This case demonstrates a failure of rivaroxaban in treating LVT in a patient with HIV-associated dilated cardiomyopathy. Good-quality randomized clinical trials or prospective studies are required to establish the efficacy and safety of DOACs for LVT treatment as an alternative to VKA.

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“…We thank Du et al for their interest in our work 1 and the authors have raised some points that we would be happy to address. Firstly, we agree with Du and colleagues as indicated their typical case regarding left ventricular thrombi (LVT) recurrences after prior resolution and discontinuation of anticoagulants, LVT recurrence may not be common when administering guideline-directed medical therapy, and if occurs, it would remain exposed to a high risk of clinical embolic events.…”

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confidence: 98%

“…

Toward reducing thrombus recurrence rate in management of patients with confirmed left ventricular thrombiWe thank Du et al for their interest in our work 1 and the authors have raised some points that we would be happy to address. Firstly, we agree with Du and colleagues as indicated their typical case regarding left ventricular thrombi (LVT) recurrences after prior resolution and discontinuation of anticoagulants, LVT recurrence may not be common when administering guideline-directed medical therapy, and if occurs, it would remain exposed to a high risk of clinical embolic events.Current guidelines recommend anticoagulant use for at least 3 months as the appropriate treatment strategy for thrombus prevention in individuals with high-risk for LVT.

…”

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confidence: 99%

Toward reducing thrombus recurrence rate in management of patients with confirmed left ventricular thrombi

2021

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Toward reducing thrombus recurrence rate in management of patients with confirmed left ventricular thrombiWe thank Du et al. for their interest in our work 1 and the authors have raised some points that we would be happy to address. Firstly, we agree with Du and colleagues as indicated their typical case regarding left ventricular thrombi (LVT) recurrences after prior resolution and discontinuation of anticoagulants, LVT recurrence may not be common when administering guideline-directed medical therapy, and if occurs, it would remain exposed to a high risk of clinical embolic events.Current guidelines recommend anticoagulant use for at least 3 months as the appropriate treatment strategy for thrombus prevention in individuals with high-risk for LVT. 2 However, in clinical practice, the clinical status is not satisfactory after anticoagulants discontinuation. Recently, in an elegant study that surveyed over 90 000 echocardiograms, Lattuca et al. 3 observed that the total LVT resolution was achieved only in 62.3% of confirmed LVT patients who were placed on anticoagulation therapy for a reported median period of 103 days (IQR: 32-392 days). Also among those who received anticoagulation (e.g. vitamin K antagonists, parenteral heparins, and direct oral anticoagulants), LVT recurrence or an increase of thrombus area was observed in a nonnegligible portion (14.5%) of patients, suggesting a need for improvement of the current anticoagulant management algorithm in LVT patients.That said, the optimal anticoagulant regimen in LVT patients is unclear, at least a simple management solution that drastically reduce thrombus recurrence rate currently does not exist. As such, decisions for establishing the rationale for longer or lifetime anticoagulant use should be made on a case-by-case basis. To tackle the current conundrum, we suggest, firstly, the frequency of follow-up imaging may be increased. Regardless the choice of therapy, repeated imaging should be performed at regular intervals.

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The prevalence, predictors, and outcomes of spontaneous echocardiographic contrast or left ventricular thrombus in patients with HFrEF

Cited by 19 publications

References 29 publications

Non-Newtonian Blood Rheology Impacts Left Atrial Stasis in Patient-Specific Simulations

Non-Newtonian Blood Rheology Impacts Left Atrial Stasis in Patient-Specific Simulations

Rivaroxaban for Treatment of Left Ventricular Thrombus: A Case Report

Toward reducing thrombus recurrence rate in management of patients with confirmed left ventricular thrombi

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