Risk Factors for Left Ventricular Thrombus Formation in Patients with Dilated Cardiomyopathy

Abstract

Background Left ventricular thrombus (LVT) is a common complication of dilated cardiomyopathy (DCM), causing morbidity and mortality. Methods This study retrospectively analyzed patients with DCM from January 2002 to August 2020 in Beijing Anzhen Hospital. Clinical characteristics were compared between the LVT group and the age and sex 1:4 matched with the LVT absent group. The receiver operator characteristic (ROC) curve was plotted to evaluate the diagnostic value of D-dimer predicting LVT occurrence in DCM. Results A total of 3,134 patients were screened, and LVT was detected in 72 (2.3%) patients on echocardiography. The patients with LVT had higher D-dimer, fibrinogen, and lower systolic blood pressure than those without LVT. The ejection fraction (EF) was lower and left ventricular end-systolic diameter was larger in the LVT group. Severe mitral regurgitation (MR) was more common in the LVT absent groups. The prevalence of atrial fibrillation was lower in the LVT group. The ROC curve analysis yielded an optimal cut-off value of 444 ng/mL DDU (D-dimer units) for D-dimer to predict the presence of LVT. Multivariable binary logistic regression analysis revealed that EF (OR = 0.90, 95% CI = 0.86–0.95), severe MR (OR = 0.19, 95% CI = 0.08–0.48), and D-dimer level (OR = 15.4, 95% CI = 7.58–31.4) were independently associated with LVT formation. Conclusion This study suggested that elevated D-dimer levels (>444 ng/mL DDU) and reduced EF were independently associated with increased risk of LVT formation. Severe MR could decrease the incidence of LVT.

Left ventricular reverse remodelling as a promising strategy for resolving left ventricular thrombus

“…31 Sharma et al reported that an increase in LV internal diastolic dimension (LVIDD) was an independent predictors of LVT formation (OR, 1.10; 95% CI, 1.03-1.18; P = 0.004), and no patients with LVIDD < 60 mm had LVT formation. 19,32 Furthermore, we observed that patients with LVRR had a lower incidence of IHD at baseline. Previous research has shown that independent correlates of LVT resolution include non-ischaemic heart disease (HR, 2.74; 95% CI, 1.43-5.26; P = 0.002) and a smaller baseline thrombus area (HR, 0.66; 95% CI 0.45-0.96; P = 0.031).…”

Identification of Novel Targets for Treatment of Dilated Cardiomyopathy Based on the Ferroptosis and Immune Heterogeneity

“…As one of the most prevalent cardiomyopathies worldwide with structural and functional abnormalities, DCM often leads to higher mortality [18][19][20] and there is no effective treatment to prevent the progression of DCM. Ferroptosis is a novel type of regulated cell death triggered by iron-dependent lipid peroxidation, which is involved in a variety of cardiovascular diseases.…”

“…14 However, there is no effective treatment for heterogeneous DCM patients, and the majority of DCM patients have poor outcomes and prognosis. [18][19][20] Moreover, the mechanism of heterogeneity in DCM patients remains uncertain. Therefore, there is an urgent need to explore the mechanism of heterogeneity in DCM patients and to identify potential targets.…”

Recent Advances in Thrombosis and Hemostasis—Part IX

“…Wu and colleagues reviewed retrospectively 3,134 patients with dilated cardiomyopathy and found that among 15 different variables, elevated D-dimer and reduced ejection fraction appeared to be independent risk factors for thrombus formation. 2 It is by now well known that patients with arterial thromboembolic disorders have an increased risk of venous thromboembolism (VTE)-and vice versa. Hu and colleagues have here investigated which cardiovascular risk factors are associated with increased or decreased risk of VTE in general, deep vein thrombosis (DVT), and pulmonary embolism.…”

“…Wu and colleagues reviewed retrospectively 3,134 patients with dilated cardiomyopathy and found that among 15 different variables, elevated D-dimer and reduced ejection fraction appeared to be independent risk factors for thrombus formation. 2…”