The prevalence of left ventricular thrombus among patients with low ejection fraction by trans-thoracic echocardiography

Abstract

Background and objectives: Ejection fraction (EF) is a measurement of heart function that reflects the portion of pumped out blood from the filled left ventricle per each heartbeat. The current study aimed to investigate the prevalence of left ventricular thrombus in patients with EF lower than 35% by using Transthoracic Echocardiography (TTE).
 Methods: In this prospective study, 82 cardiac patients underwent TTE procedure in order to assess the presence of left ventricular thrombus (LVT) from January 1st to December 31st 2017 at the Military Cardiac Centre in Sana’a, Yemen.
 Results: Out of 82 patients enrolled in this study, the mean age was 49.13 ± 14.8 years and 87.8% were male. The mean of EF was 31.16% and LVT was found in 6.1%. The spontaneous contrast was seen in 25.6% of patients indicating strong relationship with low EF (p < 0.001). Among patients with low EF, ischemic heart disease (IHD) was identified in 50%, hypertension in 30.5%, diabetes mellitus (DM) type 2 in 23.2%, and hyperlipidemia 12.2%. Exactly 80% of LVT were detected in IHD patients with dilated cardiomyopathy (DCMP) and 80% of detected LVT were apical in site.
 Conclusion: Cardiac patients with low ejection fraction developed left ventricular thrombosis, and most of the affected patients were ischemic heart disease with dilated cardiomyopathy. Interestingly, spontaneous contrast was found high significantly in these patients, which may reflect the continuous process of thrombus formation.
 Abbreviations:EF: ejection fraction, ASE: American society of echocardiography, EACVI: European association of cardiovascular imaging, LV: left ventricle, LVEF: left ventricular ejection fraction, HFpEF: heart failure with preserved ejection fraction, HFrEF: heart failure with reduced ejection fraction, MI: myocardial infarction, DCMP: dilated cardiomyopathy, AF: atrial fibrillation, TTE: Transthoracic echocardiography, TEE: trans-esophageal echocardiography, RHD: rheumatic heart disease, HTN: hypertension, DM: diabetes mellitus, CHF: congestive heart failure, JVP: jugular venous pressure, CBC: complete blood count, LFT: liver function tests, RFT: renal function test, LVT: left ventricular thrombus, ECG: electrocardiography, LVT: left ventricular thrombus, EDV: end diastolic volume, ESV: end systolic volume, SPSS: statistical package for the social sciences, IBM: international business machines, SD: standard deviation.
 doi: https://doi.org/10.12669/pjms.36.4.1972
 How to cite this:Aljaber NN, Mattash ZA, Alshoabi SA, Alhazmi FA. The prevalence of left ventricular thrombus among patients with low ejection fraction by trans-thoracic echocardiography. Pak J Med Sci. 2020;36(4):---------. doi: https://doi.org/10.12669/pjms.36.4.1972
 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Retrospective Analysis of Left Ventricular Thrombus Among Heart Failure Patients with Reduced Ejection Fraction at a Single Tertiary Care Hospital in Somalia

“…In our study, we discovered that the majority of thrombi (52.5%) were located in the apex, which is consistent with reports from Adar et al 21 and Aljaber et al 19 that LV thrombus frequently occurred in the LV apex. Benito discovered that the apex of the ventricle is the most prone to blood stasis, which explained why thrombi typically form there.…”

“…In our study, 57% of participants were associated with ischemic heart disease (IHD). This result is consistent with that of Aljaber et al 19 and Khaled et al, 20 who discovered that the prevalence of IHD in people with left ventricle thrombus and HFrEF was 50% and 51%, respectively.…”

“…18 In this study we found LV thrombus in 16% of the patients. This frequency is higher than those reported by Aljaber et al 19 and Talle et al, 12 respectively, for Yemen (6.1%) and Nigeria (8.85%). To our knowledge, this is the first study on the prevalence of LVT among heart failure patients from Somalia.…”

Prevalence and incidence of stroke, white matter hyperintensities, and silent brain infarcts in patients with chronic heart failure: A systematic review, meta-analysis, and meta-regression

“…In our subgroup analysis of HF with varying levels of LVEF, there is a lower prevalence of IS in patients with HFpEF at 2.97% than in patients with HFrEF at 3.69%. This may be consistent with the theory that a lower ejection fraction leads to stasis and the increased formation of LV thrombus (86), which may embolize to the brain. Nevertheless, the relationship between LVEF and IS is not well documented (87).…”

Right Anterior Minithoracotomy Is an Alternative, Less Invasive Approach to Median Sternotomy during Aortic Valve Replacement for Patients with Low Left Ventricular Ejection Fraction

“…The main information available focused on the ministernotomy approaches; only a few studies evaluated the right anterior minithoracotomy approach for aortic valve disease, which revealed some advantages in terms of low incidence of atrial fibrillation and less blood transfusion and duration of mechanical ventilation [18][19][20][21]. Left ventricular ejection fraction (LVEF) refers to the ratio of stroke volume to end diastolic volume, which is an essential measurement of cardiac function [22,23]. Reduced LVEF may be associated with worse patient outcomes, while the optimal threshold for "normal" LVEF is uncertain.…”