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Fujino M, Aikawa H, Nakao K, Takagi K, Otsuka F, Kataoka Y, Asaumi Y, Sumita Y, Nakai M, Kanaoka K, Miyamoto Y, Nicholls SJ, Noguchi T. Comparison of embolic risk in left ventricular thrombus between nonischemic and ischemic cardiomyopathy: A nationwide database analysis. Int J Cardiol 2024; 411:132329. [PMID: 38964554 DOI: 10.1016/j.ijcard.2024.132329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 06/24/2024] [Accepted: 07/01/2024] [Indexed: 07/06/2024]
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. METHODS AND 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.
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Affiliation(s)
- Masashi Fujino
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular (NCVC) Center, Osaka, Japan; Victorian Heart Institute, Monash University, Melbourne, Australia.
| | - Hirohiko Aikawa
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular (NCVC) Center, Osaka, Japan
| | - Kazuhiro Nakao
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular (NCVC) Center, Osaka, Japan
| | - Kensuke Takagi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular (NCVC) Center, Osaka, Japan
| | - Fumiyuki Otsuka
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular (NCVC) Center, Osaka, Japan
| | - Yu Kataoka
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular (NCVC) Center, Osaka, Japan
| | - Yasuhide Asaumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular (NCVC) Center, Osaka, Japan
| | - Yoko Sumita
- Department of Medical and Health Information Management, NCVC, Osaka, Japan
| | - Michikazu Nakai
- Department of Medical and Health Information Management, NCVC, Osaka, Japan; Clinical Research Support Center, University of Miyazaki Hospital, Miyazaki, Japan
| | - Koshiro Kanaoka
- Department of Medical and Health Information Management, NCVC, Osaka, Japan
| | - Yoshihiro Miyamoto
- Department of Medical and Health Information Management, NCVC, Osaka, Japan
| | | | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular (NCVC) Center, Osaka, Japan
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Radakrishnan A, Dokko J, Pastena P, Kalogeropoulos AP. Thromboembolism in peripartum cardiomyopathy: a systematic review. J Thorac Dis 2024; 16:645-660. [PMID: 38410599 PMCID: PMC10894371 DOI: 10.21037/jtd-23-945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 12/01/2023] [Indexed: 02/28/2024]
Abstract
Background Women with peripartum cardiomyopathy (PPCM) are at an increased risk of arterial and venous thromboembolic events. The review summarizes the evidence on the incidence of thromboembolic complications in women with PPCM, diagnostic approaches, related outcomes, and effects of therapies that have been used. Methods English articles were retrieved from Web of Science and PubMed using search terms to capture studies related to PPCM (or postpartum cardiomyopathy) and all combinations of thrombosis- and embolism-related keywords. A total of 347 articles from PubMed and 85 from Web of Science were obtained, and after removing duplicates, 327 articles were screened for original data and classified into four domains: epidemiology, risk factors, diagnosis, and therapy of thromboembolism in PPCM. Ultimately, 30 articles were included. Data were synthesized in summary tables for each domain. Results Studies in the United States and Europe reported varying incidence for thromboembolism in PPCM, up to 14% in 6 months. Risk factors include elevated levels of coagulation factors, decreased protein C and S activity, decreased fibrinolysis, and a low left ventricular ejection fraction (LVEF). Cesarean delivery and post-operative status were correlated with a higher incidence of thromboembolic complications. Diagnosis relied mostly on ultrasonography and magnetic resonance and depended on the suspected location of thrombus. Anticoagulation has been used mostly for PPCM patients with a reduced LVEF, with the duration varying across guidelines and healthcare systems. Unfractionated heparin and low molecular weight heparin (LMWH) were considered safe choices during pregnancy, while warfarin and novel oral anticoagulants (NOACs) were used postpartum. The association of bromocriptine with risk of thromboembolic complications remains debated. Conclusions There are important gaps in our understanding of the epidemiology, risk stratification, and optimal secondary prevention of thromboembolism in PPCM. Larger prospective studies with detailed phenotyping are required.
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Affiliation(s)
| | - Julia Dokko
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Paola Pastena
- Division of Cardiology, Stony Brook University, Stony Brook, NY, USA
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Kwok CS, Abbas KS, Qureshi AI, Lip GYH. Cerebral infarction and in-hospital mortality for patients admitted to hospital with intracardiac thrombus: insights from the National Inpatient Sample. J Thromb Thrombolysis 2023:10.1007/s11239-023-02824-8. [PMID: 37277607 DOI: 10.1007/s11239-023-02824-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2023] [Indexed: 06/07/2023]
Abstract
The factors associated with cerebral infarction and mortality in patients hospitalized with intracardiac thrombus are unknown. A retrospective cohort study was undertaken of nationally representative hospital admissions in the National Inpatient Sample with a diagnosis of intracardiac thrombus between 2016 to 2019. Multiple logistic regressions were used to define factors associated with cerebral infarction and in-hospital mortality. There were a total of 175,370 admissions for patients with intracardiac thrombus and 10.1% patients had cerebral infarction (n = 17,675). Intracardiac thrombus represented 4.4% of primary diagnosis for admissions while circulatory conditions (65.4%), infection (5.9%), gastrointestinal conditions (4.4%), respiratory conditions (4.4%) and cancer (2.2%) were the other prevalent primary diagnoses. All-cause mortality was higher for patients with cerebral infarction (8.5% vs 4.8%). The five factors most associated with cerebral infarction were nephrotic syndrome (OR 2.67 95%CI 1.05-6.78), other thrombophilia (OR 2.12 95%CI 1.52-2.95), primary thrombophilia (OR 1.99 95%CI 1.52-2.53), previous stroke (OR 1.61 95%CI 1.47-1.75) and hypertension (OR 1.41 95%CI 1.27-1.56). The strongest independent predictors of death were heparin induced thrombocytopenia (OR 2.45 95%CI 150-4.00), acute venous thromboembolism (OR 2.03 95%CI 1.78-2.33, p < 0.001) acute myocardial infarction (OR 1.95 95%CI 1.72-2.22), arterial thrombosis (OR 1.75 95%CI 1.39-2.20) and cancer (OR 1.57 95%CI 1.36-1.81). Patients with intracardiac thrombus are at risk of cerebral infarction and in-hospital mortality. Nephrotic syndrome, thrombophilia, previous stroke, hypertension, and heparin induced thrombocytopenia were associated with cerebral infarction, while acute venous thromboembolism, acute myocardial infarction, and cancer were predictors of mortality.
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Affiliation(s)
- Chun Shing Kwok
- Department of Post Qualifying Healthcare Practice, Birmingham City University, Birmingham, UK.
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK.
| | | | - Adnan I Qureshi
- Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, MO, USA
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Wolfe DS, Liu C, Alboucai J, Karten A, Mushi J, Yellin S, Berkowitz JL, Vega S, Felix N, Liaqat W, Kankaria R, Vorawandthanachai T, Bortnick AE. Maternal Outcomes in Women with Peripartum Cardiomyopathy versus Age and Race-Matched Peers in an Urban US Community. J Cardiovasc Dev Dis 2022; 9:jcdd9080250. [PMID: 36005414 PMCID: PMC9410188 DOI: 10.3390/jcdd9080250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 11/16/2022] Open
Abstract
Peripartum cardiomyopathy (PPCM) is idiopathic systolic congestive heart failure around pregnancy. Comparisons with matched controls are lacking. We investigated maternal characteristics and outcomes up to 12 months in a cohort admitted to Montefiore Health System in Bronx, New York 1999−2015 (n = 53 cases and n = 92 age and race-matched controls, >80% Black or Hispanic/Latina). Compared to peers, women with PPCM had more chronic hypertension (24.5% vs. 8.8%, p = 0.001), prior gestational hypertension (20.8% vs. 5.4%, p = 0.001), prior preeclampsia (17.0% vs. 3.3%, p = 0.001), familial dilated cardiomyopathy (5.7% vs. 0.0%, p = 0.04), smoking (15.1% vs. 2.2%, p = 0.001), lower summary socioeconomic scores (−4.12 (IQR −6.81, −2.13) vs. −1.62 (IQR −4.20, −0.74), p < 0.001), public insurance (67.9% vs. 29.3% p = 0.001), and frequent depressive symptoms. Women with PPCM were often admitted antepartum (34.0% vs. 18.5%, p = 0.001) and underwent Cesarean section (65.4% vs. 30.4%, p = 0.001), but had less preterm labor (27.3% vs. 51.1%, p = 0.001). Women were rarely treated with bromocriptine (3.8%), frequently underwent left ventricular assist device placement (9.4% and n = 2 with menorrhagia requiring transfusion and progesterone) or heart transplantation (3.8%), but there were no in-hospital deaths. In sum, women with PPCM had worse socioeconomic disadvantage and baseline health than matched peers. Programs addressing social determinants of health may be important for women at high risk of PPCM.
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Affiliation(s)
- Diana S. Wolfe
- Department of Obstetrics and Gynecology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Maternal Fetal Medicine-Cardiology Joint Program, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Correspondence:
| | - Christina Liu
- Department of Emergency Medicine, Woodhull Medical and Mental Health Center, Brooklyn, NY 11206, USA
| | - Jack Alboucai
- Department of Medicine, North Shore University Hospital, Manhasset, NY 11030, USA
| | - Ariel Karten
- Department of Medicine, Division of Cardiology, New York University Long Island School of Medicine, Mineola, NY 11501, USA
| | - Juliet Mushi
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University Maternal Fetal Medicine, Greenwich Hospital, Greenwich, CT 06830, USA
| | - Shira Yellin
- Department of Medicine, Mount Sinai Health System, New York, NY 10029, USA
| | - Julia L. Berkowitz
- Department of Medicine, Brown University Warren Alpert Medical School, Providence, RI 02903, USA
| | - Shayna Vega
- Department of Obstetrics and Gynecology, Kaiser Permanente Oakland Medical Center, Oakland, CA 94611, USA
| | - Nicole Felix
- Department of Psychiatry and Human Behavior, Brown University Warren Alpert Medical School, Providence, RI 02903, USA
| | - Wasla Liaqat
- Department of Medicine, New York Health and Hospitals Jacobi Medical Center, Bronx, NY 10461, USA
| | - Rohan Kankaria
- Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | | | - Anna E. Bortnick
- Maternal Fetal Medicine-Cardiology Joint Program, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Department of Medicine, Division of Geriatrics, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
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