PDF(Pubmed)
Abstract：
UNASSIGNED: Recommendations for drug treatment of left ventricular thrombus (LVT) are based on the ST-segment elevation myocardial infarction (STEMI) guidelines; however, the etiology of LVT has changed. Due to the lack of evidence regarding LVT treatment in the heart failure population, current heart failure guidelines do not cover LVT treatment. We sought to review the etiology of LVT and changes in antithrombotic therapy over the previous 12 years and explore the impact of anticoagulation treatment from a single center\'s experience.
UNASSIGNED: From January 2009 to June 2021, we studied 1675 patients with a discharge diagnosis of LVT at a single center to investigate the clinical characteristics, incidence of all-cause death, cardiovascular death, ischemic stroke, major adverse cardiac and cerebrovascular events (MACCE), systemic embolism (SE), and major bleeding events. Patients were divided into an anticoagulant group and a non-anticoagulant group according to whether they received oral anticoagulant therapy at discharge.
UNASSIGNED: The study included 909 patients (anticoagulation, 510; no anticoagulation, 399). While overall antiplatelet therapy dramatically decreased, more patients with LVT received oral anticoagulation in 2021 (74.0%) than in 2009 (29.6%). In addition, more than half of the patients had heart failure with reduced ejection fraction (HFrEF) each year. The all-cause mortality was 17.3% during 3.8 years of follow-up. The incidences of cardiovascular death, stroke, MACCE, SE, and major bleeding were 16.0%, 3.3%, 19.8%, 5.1%, and 1.7%, respectively. The anticoagulation group had a significantly higher proportion of dilated cardiomyopathy than the non-anticoagulation group (24.7% vs. 5.5%, p < 0.001), and a lower LVEF (34.0 vs. 41.0, p < 0.001). The anticoagulation group also had a higher probability of adverse events on long-term follow-up (p > 0.05). A multivariable competing risk regression model found no significant difference in all six endpoints between the groups (all p > 0.05). Similar results were found by matched and weighted data analysis. Diabetes mellitus (hazard ratio (HR), 1.42; 95% confidence interval (CI), 1.04-1.93; p = 0.027), renal insufficiency (HR, 2.36; 95% CI, 1.60-3.50; p < 0.001), history of previous stroke (HR, 1.60; 95% CI, 1.13-2.29; p = 0.009), and HFrEF (HR, 2.54; 95% CI, 1.78-3.64; p < 0.001) were predictors of increased risk of MACCE.
UNASSIGNED: Heart failure, rather than acute myocardial infarction, is currently the primary cause of LVT. A trend towards better prognosis in the no anticoagulation group was noted. Multivariable, matching and weighting analysis showed no improvement in prognosis with anticoagulant therapy. Our study does not negate the efficacy of anticoagulation but suggests the need to strengthen the management of anticoagulation in order to achieve better efficacy.
UNASSIGNED: From January 2009 to June 2021, we studied 1675 patients with a discharge diagnosis of LVT at a single center to investigate the clinical characteristics, incidence of all-cause death, cardiovascular death, ischemic stroke, major adverse cardiac and cerebrovascular events (MACCE), systemic embolism (SE), and major bleeding events. Patients were divided into an anticoagulant group and a non-anticoagulant group according to whether they received oral anticoagulant therapy at discharge.
UNASSIGNED: The study included 909 patients (anticoagulation, 510; no anticoagulation, 399). While overall antiplatelet therapy dramatically decreased, more patients with LVT received oral anticoagulation in 2021 (74.0%) than in 2009 (29.6%). In addition, more than half of the patients had heart failure with reduced ejection fraction (HFrEF) each year. The all-cause mortality was 17.3% during 3.8 years of follow-up. The incidences of cardiovascular death, stroke, MACCE, SE, and major bleeding were 16.0%, 3.3%, 19.8%, 5.1%, and 1.7%, respectively. The anticoagulation group had a significantly higher proportion of dilated cardiomyopathy than the non-anticoagulation group (24.7% vs. 5.5%, p < 0.001), and a lower LVEF (34.0 vs. 41.0, p < 0.001). The anticoagulation group also had a higher probability of adverse events on long-term follow-up (p > 0.05). A multivariable competing risk regression model found no significant difference in all six endpoints between the groups (all p > 0.05). Similar results were found by matched and weighted data analysis. Diabetes mellitus (hazard ratio (HR), 1.42; 95% confidence interval (CI), 1.04-1.93; p = 0.027), renal insufficiency (HR, 2.36; 95% CI, 1.60-3.50; p < 0.001), history of previous stroke (HR, 1.60; 95% CI, 1.13-2.29; p = 0.009), and HFrEF (HR, 2.54; 95% CI, 1.78-3.64; p < 0.001) were predictors of increased risk of MACCE.
UNASSIGNED: Heart failure, rather than acute myocardial infarction, is currently the primary cause of LVT. A trend towards better prognosis in the no anticoagulation group was noted. Multivariable, matching and weighting analysis showed no improvement in prognosis with anticoagulant therapy. Our study does not negate the efficacy of anticoagulation but suggests the need to strengthen the management of anticoagulation in order to achieve better efficacy.
摘要：
■关于左心室血栓（LVT）的药物治疗的建议是基于ST段抬高型心肌梗死（STEMI）指南；然而，LVT的病因发生了改变。由于缺乏关于心力衰竭人群LVT治疗的证据，目前的心力衰竭指南不包括LVT治疗.我们试图回顾过去12年中LVT的病因和抗血栓治疗的变化，并从单个中心的经验中探讨抗凝治疗的影响。
■从2009年1月到2021年6月，我们在单个中心研究了1675例出院诊断为LVT的患者，以调查其临床特征，全因死亡的发生率，心血管死亡,缺血性卒中,主要不良心脑血管事件（MACCE），全身性栓塞（SE），和大出血事件。根据患者出院时是否接受口服抗凝治疗分为抗凝组和非抗凝组。
■该研究包括909名患者（抗凝，510;无抗凝,399).虽然整体抗血小板治疗急剧下降，与2009年(29.6%)相比,2021年接受口服抗凝治疗的LVT患者更多(74.0%).此外,每年有超过一半的患者出现射血分数(HFrEF)降低的心力衰竭.在3.8年的随访期间，全因死亡率为17.3%。心血管死亡的发生率，中风,MACCE,SE,大出血为16.0%,3.3%,19.8%,5.1%,和1.7%，分别。抗凝组扩张型心肌病的比例明显高于非抗凝组（24.7%vs.5.5%,p<0.001)，和较低的LVEF(34.0vs.41.0，p<0.001)。抗凝组在长期随访中出现不良事件的概率也较高(p>0.05)。多变量竞争风险回归模型发现两组间6个终点均无显著差异(均P>0.05)。通过匹配和加权数据分析发现了类似的结果。糖尿病（危险比（HR），1.42；95%置信区间(CI)，1.04-1.93；p=0.027），肾功能不全（HR，2.36；95%CI，1.60-3.50；p<0.001），既往卒中病史（HR，1.60；95%CI，1.13-2.29；p=0.009），和HFrEF(HR，2.54；95%CI，1.78-3.64；p<0.001）是MACCE风险增加的预测因子。
■心力衰竭,而不是急性心肌梗塞，是目前LVT的主要原因。观察到非抗凝组预后更好的趋势。多变量,匹配和加权分析显示,抗凝治疗对预后无改善.我们的研究并没有否定抗凝的疗效，但建议需要加强抗凝管理以获得更好的疗效。
■从2009年1月到2021年6月，我们在单个中心研究了1675例出院诊断为LVT的患者，以调查其临床特征，全因死亡的发生率，心血管死亡,缺血性卒中,主要不良心脑血管事件（MACCE），全身性栓塞（SE），和大出血事件。根据患者出院时是否接受口服抗凝治疗分为抗凝组和非抗凝组。
■该研究包括909名患者（抗凝，510;无抗凝,399).虽然整体抗血小板治疗急剧下降，与2009年(29.6%)相比,2021年接受口服抗凝治疗的LVT患者更多(74.0%).此外,每年有超过一半的患者出现射血分数(HFrEF)降低的心力衰竭.在3.8年的随访期间，全因死亡率为17.3%。心血管死亡的发生率，中风,MACCE,SE,大出血为16.0%,3.3%,19.8%,5.1%,和1.7%，分别。抗凝组扩张型心肌病的比例明显高于非抗凝组（24.7%vs.5.5%,p<0.001)，和较低的LVEF(34.0vs.41.0，p<0.001)。抗凝组在长期随访中出现不良事件的概率也较高(p>0.05)。多变量竞争风险回归模型发现两组间6个终点均无显著差异(均P>0.05)。通过匹配和加权数据分析发现了类似的结果。糖尿病（危险比（HR），1.42；95%置信区间(CI)，1.04-1.93；p=0.027），肾功能不全（HR，2.36；95%CI，1.60-3.50；p<0.001），既往卒中病史（HR，1.60；95%CI，1.13-2.29；p=0.009），和HFrEF(HR，2.54；95%CI，1.78-3.64；p<0.001）是MACCE风险增加的预测因子。
■心力衰竭,而不是急性心肌梗塞，是目前LVT的主要原因。观察到非抗凝组预后更好的趋势。多变量,匹配和加权分析显示,抗凝治疗对预后无改善.我们的研究并没有否定抗凝的疗效，但建议需要加强抗凝管理以获得更好的疗效。
