Echocardiographic measures associated with the presence of left ventricular thrombus in patients with chemotherapy‐related cardiac dysfunction

Kitkungvan, Danai; Yusuf, Salim; Moudgil, Rohit; Palaskas, Nicolas; Guindani, Michele; Song, Juhee; Hassan, Saamir; Sanchez, Liza; Banchs, José

doi:10.1111/echo.14087

Cited by 6 publications

(7 citation statements)

References 49 publications

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“…30 Inflammation, hypercoagulability, and endocardial involvement by specific disease processes (eg, amyloidosis, eosinophilic myocarditis) are also important pathophysiological mediators in DCM that may increase the risk of LV thrombus formation. [31][32][33][34][35][36] However, data in relation to specific DCM causes are sparse on both LV thrombus risk and the impact on clinically relevant thrombus/thromboembolism.…”

Section: Clinical Statements and Guidelinesmentioning

confidence: 99%

“…8,78 A small number of case reports and case series of LV thrombus have been reported in patients with other forms of DCM, including hypertrophic cardiomyopathy, chemotherapy-related cardiomyopathy, cardiac amyloidosis, cardiomyopathy attributable to Chagas disease, and eosinophilic myocarditis. [31][32][33][34][35] No prospective observational studies or randomized clinical trials have evaluated the impact of anticoagulation in these patients for the primary prevention of LV thrombus.…”

Section: Clinical Statements and Guidelinesmentioning

confidence: 99%

See 1 more Smart Citation

Management of Patients at Risk for and With Left Ventricular Thrombus: A Scientific Statement From the American Heart Association

Levine¹,

McEvoy²,

Fang³

et al. 2022

Circulation

116

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Despite the many advances in cardiovascular medicine, decisions concerning the diagnosis, prevention, and treatment of left ventricular (LV) thrombus often remain challenging. There are only limited organizational guideline recommendations with regard to LV thrombus. Furthermore, management issues in current practice are increasingly complex, including concerns about adding oral anticoagulant therapy to dual antiplatelet therapy, the availability of direct oral anticoagulants as a potential alternative option to traditional vitamin K antagonists, and the use of diagnostic modalities such as cardiac magnetic resonance imaging, which has greater sensitivity for LV thrombus detection than echocardiography. Therefore, this American Heart Association scientific statement was commissioned with the goals of addressing 8 key clinical management questions related to LV thrombus, including the prevention and treatment after myocardial infarction, prevention and treatment in dilated cardiomyopathy, management of mural (laminated) thrombus, imaging of LV thrombus, direct oral anticoagulants as an alternative to warfarin, treatments other than oral anticoagulants for LV thrombus (eg, dual antiplatelet therapy, fibrinolysis, surgical excision), and the approach to persistent LV thrombus despite anticoagulation therapy. Practical management suggestions in the form of text, tables, and flow diagrams based on careful and critical review of actual study data as formulated by this multidisciplinary writing committee are given.

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Section: Clinical Statements and Guidelinesmentioning

confidence: 99%

Section: Clinical Statements and Guidelinesmentioning

confidence: 99%

Management of Patients at Risk for and With Left Ventricular Thrombus: A Scientific Statement From the American Heart Association

Levine¹,

McEvoy²,

Fang³

et al. 2022

Circulation

116

View full text Add to dashboard Cite

show abstract

“…17 In DCM of autoimmune, toxic, and infectious causes (also known as inflammatory cardiomyopathies), inflammation plays the primary and persistent pathologic role, 18 and several studies have observed a high prevalence of intracardiac thrombus in inflammatory cardiomyopathy populations. 19,20…”

Section: Discussionmentioning

confidence: 99%

Clinical Profile, Treatment, and Prognosis of Left Ventricular Thrombus in Dilated Cardiomyopathy

Huang

Zhao

Wang

et al. 2023

Clin Appl Thromb Hemost

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Despite the emerging prevalence of left ventricular (LV) thrombus in dilated cardiomyopathy (DCM), clinical characteristics, management, and disease prognosis are poorly studied. We aim to assess the efficacy/safety profile of direct oral anticoagulants (DOACs) compared to warfarin by evaluating thrombus evolution, risk for stroke and systemic embolism (SSE), heart failure (HF) rehospitalization, all-cause mortality, and major adverse cardiovascular events (MACEs), and determine the impact of thrombus evolution on adverse events. We performed a historical cohort study of patients with a primary diagnosis of DCM and LV thrombus. Relationships between anticoagulants and thrombus resolution were analyzed with the Kaplan-Meier method and Cox regression. Associations between longitudinal thrombus evolution and adverse event hazard were measured with joint modeling. Among 122 patients included, 58.0% were prescribed warfarin, and 42.0% DOACs. Complete thrombus resolution at 90-day-after-index and 180-day-after-index was observed in 93 and 111 patients, with no difference in cumulative resolution between DOACs and warfarin. During a median follow-up of 12.5 months, MACE, all-cause death, SSE, and HF rehospitalization occurred in 42.6%, 27.9%, 4.1%, and 13.9% of patients, comparable in warfarin and DOACs groups. Thrombus persistence was associated with a higher risk of HF rehospitalization. Thrombus progression was associated with poor prognosis, with per unit increment in square-root-transformed thrombus-area resulting in a 1.0691-fold increase in MACE risk and a 1.0546-fold increase in death risk. This study suggests that in DCM patients with LV thrombus, DOACs were comparable to warfarin in thrombus resolution and safety profile. Thrombus persistence or progression was associated with an increased risk of HF rehospitalization, MACE, and mortality.

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“…Retrospective [24] Iodine densities were significantly lower in the LVT than the LV cavity, whereas blood densities in the two areas did not differ significantly Mao, 2018…”

Section: Prevalence and Risk Factorsmentioning

confidence: 96%

“…In a cohort of patients (n=121) with chemotherapyrelated severe LV dysfunction (24), defined as LVEF <30%, the prevalence of LVT was 7.4%. Factors associated with presence of LVT were restrictive filling pattern (OR: 18.13, 95% CI: 4.17-78.89) and LVEF <20% (OR: 36.30, 95% CI: 7.35-179.25).…”

Section: Prevalence and Risk Factorsmentioning

confidence: 99%

Management of left ventricular thrombus: a narrative review

2021

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Left ventricular thrombus (LVT) is a serious complication of acute myocardial infarction (MI) and also non-ischemic cardiomyopathies. We performed a narrative literature review, manual-search of reference lists of included articles and relevant reviews. Our literature review indicates that the incidence of LVT following acute MI has decreased, probably due to improvement in patient care as a result of better and earlier reperfusion techniques. Predictors of LVT include anterior MI, involvement of left ventricular (LV) apex (regardless of the coronary territory affected), LV akinesis or dyskinesis, reduced LV ejection fraction (LVEF), severe diastolic dysfunction and large infarct size. LVT is associated with increased risk of systemic embolism, stroke, cardiovascular events and death, and there is evidence that anticoagulant therapy for at least 3 months can reduce the risk of these events. Cardiac magnetic resonance (CMR) has the highest diagnostic accuracy for LVT, followed by echocardiography with the use of echocardiographic contrast agents (ECAs). Although current guidelines suggest use of vitamin K antagonist (VKA) for a minimum of 3 to 6 months, there is growing evidence of the benefits of direct acting oral anticoagulants in treatment of LVT. Embolic events appear to occur even after resolution of LVT suggesting that anticoagulant therapy needs to be considered for a longer period in some cases. Recommendations for the use of triple therapy in the presence of the LVT are mostly based on extrapolation from outcome data in patients with atrial fibrillation (AF) and MI. We conclude that the presence of LVT is more likely in patients with anterior STsegment elevation MI (STEMI) (involving the apex) and reduced ejection fraction (EF). LVT should be considered a marker of increased long-term thrombotic risk that may persist even after thrombus resolution.Ongoing clinical trials are expected to elucidate the best management strategies for patients with LVT.

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Echocardiographic measures associated with the presence of left ventricular thrombus in patients with chemotherapy‐related cardiac dysfunction

Abstract: In patients with severely reduced LV systolic function due to chemotherapy-induced cardiomyopathy, LV thrombus was found in 7.4% of subjects. Severely decreased LVEF (<20%) and restrictive LV filling pattern were associated with the presence of LV thrombus.

Cited by 6 publications

References 49 publications

Management of Patients at Risk for and With Left Ventricular Thrombus: A Scientific Statement From the American Heart Association

Management of Patients at Risk for and With Left Ventricular Thrombus: A Scientific Statement From the American Heart Association

Clinical Profile, Treatment, and Prognosis of Left Ventricular Thrombus in Dilated Cardiomyopathy

Management of left ventricular thrombus: a narrative review

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