Abstract：
BACKGROUND: Left ventricular (LV) thrombus is not common but poses significant risks of embolic stroke or systemic embolism. However, the distinction in embolic risk between nonischemic cardiomyopathy (NICM) and ischemic cardiomyopathy (ICM) remains unclear.
RESULTS: In total, 2738 LV thrombus patients from the JROAD-DPC (Japanese Registry of All Cardiac and Vascular Diseases Diagnosis Procedure Combination) database were included. Among these patients, 1037 patients were analyzed, with 826 (79.7%) having ICM and 211 with NICM (20.3%). Within the NICM group, the distribution was as follows: dilated cardiomyopathy (DCM; 41.2%), takotsubo cardiomyopathy (27.0%), hypertrophic cardiomyopathy (18.0%), and other causes (13.8%). The primary outcome was a composite of embolic stroke or systemic embolism (SSE) during hospitalization. The ICM and NICM groups showed no significant difference in the primary outcome (5.8% vs. 7.6%, p = 0.34). Among NICM, SSE occurred in 12.6% of patients with DCM, 7.0% with takotsubo cardiomyopathy, and 2.6% with hypertrophic cardiomyopathy. Multivariate logistic regression analysis for SSE revealed an odds ratio of 1.4 (95% confidence interval [CI], 0.7-2.7, p = 0.37) for NICM compared to ICM. However, DCM exhibited a higher adjusted odds ratio for SSE compared to ICM (2.6, 95% CI 1.2-6.0, p = 0.022).
CONCLUSIONS: This nationwide shows comparable rates of embolic events between ICM and NICM in LV thrombus patients, with DCM posing a greater risk of SSE than ICM. The findings emphasize the importance of assessing the specific cause of heart disease in NICM, within LV thrombus management strategies.
RESULTS: In total, 2738 LV thrombus patients from the JROAD-DPC (Japanese Registry of All Cardiac and Vascular Diseases Diagnosis Procedure Combination) database were included. Among these patients, 1037 patients were analyzed, with 826 (79.7%) having ICM and 211 with NICM (20.3%). Within the NICM group, the distribution was as follows: dilated cardiomyopathy (DCM; 41.2%), takotsubo cardiomyopathy (27.0%), hypertrophic cardiomyopathy (18.0%), and other causes (13.8%). The primary outcome was a composite of embolic stroke or systemic embolism (SSE) during hospitalization. The ICM and NICM groups showed no significant difference in the primary outcome (5.8% vs. 7.6%, p = 0.34). Among NICM, SSE occurred in 12.6% of patients with DCM, 7.0% with takotsubo cardiomyopathy, and 2.6% with hypertrophic cardiomyopathy. Multivariate logistic regression analysis for SSE revealed an odds ratio of 1.4 (95% confidence interval [CI], 0.7-2.7, p = 0.37) for NICM compared to ICM. However, DCM exhibited a higher adjusted odds ratio for SSE compared to ICM (2.6, 95% CI 1.2-6.0, p = 0.022).
CONCLUSIONS: This nationwide shows comparable rates of embolic events between ICM and NICM in LV thrombus patients, with DCM posing a greater risk of SSE than ICM. The findings emphasize the importance of assessing the specific cause of heart disease in NICM, within LV thrombus management strategies.
摘要：
背景：左心室（LV）血栓并不常见，但存在栓塞性卒中或全身性栓塞的重大风险。然而,非缺血性心肌病(NICM)和缺血性心肌病(ICM)栓塞风险的区别尚不清楚.
结果：总计，纳入了来自JROAD-DPC（日本注册所有心脏和血管疾病诊断程序组合）数据库的2738名LV血栓患者。在这些患者中,对1037例患者进行了分析，其中826人(79.7%)拥有ICM，211人拥有NICM(20.3%)。在NICM组中，分布如下：扩张型心肌病（DCM；41.2%），Takotsubo心肌病（27.0％），肥厚型心肌病（18.0%），及其他原因(13.8%)。主要结局是住院期间栓塞性中风或全身性栓塞（SSE）的复合结局。ICM和NICM组在主要结局方面没有显着差异（5.8％vs.7.6%,p=0.34）。在NICM中，12.6%的DCM患者发生SSE,7.0%患有takotsubo心肌病，和2.6％的肥厚型心肌病。SSE的多变量逻辑回归分析显示比值比为1.4(95%置信区间[CI]，与ICM相比，NICM为0.7-2.7，p=0.37）。然而,与ICM相比，DCM表现出更高的SSE调整后比值比(2.6，95%CI1.2-6.0，p=0.022)。
结论：这表明，在左心室血栓患者中，ICM和NICM之间的栓塞事件发生率相当，DCM比ICM具有更大的SSE风险。研究结果强调了在NICM中评估心脏病的具体原因的重要性，在LV血栓管理策略中。
结果：总计，纳入了来自JROAD-DPC（日本注册所有心脏和血管疾病诊断程序组合）数据库的2738名LV血栓患者。在这些患者中,对1037例患者进行了分析，其中826人(79.7%)拥有ICM，211人拥有NICM(20.3%)。在NICM组中，分布如下：扩张型心肌病（DCM；41.2%），Takotsubo心肌病（27.0％），肥厚型心肌病（18.0%），及其他原因(13.8%)。主要结局是住院期间栓塞性中风或全身性栓塞（SSE）的复合结局。ICM和NICM组在主要结局方面没有显着差异（5.8％vs.7.6%,p=0.34）。在NICM中，12.6%的DCM患者发生SSE,7.0%患有takotsubo心肌病，和2.6％的肥厚型心肌病。SSE的多变量逻辑回归分析显示比值比为1.4(95%置信区间[CI]，与ICM相比，NICM为0.7-2.7，p=0.37）。然而,与ICM相比，DCM表现出更高的SSE调整后比值比(2.6，95%CI1.2-6.0，p=0.022)。
结论：这表明，在左心室血栓患者中，ICM和NICM之间的栓塞事件发生率相当，DCM比ICM具有更大的SSE风险。研究结果强调了在NICM中评估心脏病的具体原因的重要性，在LV血栓管理策略中。
