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Che Y, Huang S, Zhou W, Shi S, Ye F, Ji Y, Huang J. Association between neutrophil-to-lymphocyte ratio and outcomes in hospitalized patients with left ventricular thrombus. Coron Artery Dis 2024; 35:397-404. [PMID: 38563191 PMCID: PMC11198952 DOI: 10.1097/mca.0000000000001363] [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: 01/12/2024] [Accepted: 03/16/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Left ventricular thrombus (LVT) is a severe cardiovascular complication occurring in approximately 10% of patients with acute anterior ST-segment elevation myocardial infarction. This study aimed to evaluate the association between neutrophil-to-lymphocyte ratio (NLR) and in-hospital major adverse cardiovascular and cerebrovascular events (MACCE) in patients with LVT. MATERIAL AND METHODS This multicenter retrospective study was conducted between January 2000 and June 2022 in hospitalized patients with LVT. The outcome included in-hospital MACCE. The association between NLR and in-hospital MACCE was measured by odds ratios (ORs). The restricted cubic spline model was used for dose-response analysis. RESULTS A total of 197 LVT patients from four centers were included for analysis in this study. MACCE occurred in 13.7% (27/197) of the patients. After adjusting for estimated glomerular filtration rate (eGFR), D-dimer, and age, the OR for MACCE comparing first to the third tertile of NLR was 13.93 [95% confidence interval: 2.37-81.77, P = 0.004, P -trend = 0.008]. When further adjusting for etiology and heart failure with reduced ejection fraction (HFrEF), the association remained statistically significant. Spline regression models showed an increasing trend in the incidence of MACCEs with NLR both in crude and adjusted models. Subgroup analyses showed that a high NLR may be correlated with poorer outcomes for LVT patients older than 65 years, or with hypertension, dyslipidemia, low ejection fraction, liver, and renal dysfunctions. CONCLUSION In conclusion, these findings suggested that higher NLR may be associated with an increased risk of in-hospital MACCE in patients with LVT.
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Affiliation(s)
| | - Shenglan Huang
- Department of Cardiology, the Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou
| | - Wei Zhou
- Department of Cardiology, Yixing People’s Hospital, Yixing
| | - Shunyi Shi
- Department of Cardiology, the Third Affiliated Hospital of Soochow University, Changzhou
| | - Fei Ye
- Department of Cardiology, Nanjing First Hospital, Nanjing
| | - Yuan Ji
- Department of Cardiology, the Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou
| | - Jun Huang
- Department of Echocardiology, the Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, China
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Chen Q, Zhang Z, Chen L, Zhou Z, Lu Y, Zhang C, Li C, Zhang Z, Chen W. Association between cardiac magnetic resonance ventricular strain and left ventricular thrombus in patients with ST-segment elevation myocardial infarction. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024:10.1007/s10554-024-03163-2. [PMID: 38884697 DOI: 10.1007/s10554-024-03163-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 06/11/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND Myocardial strain can analyze early myocardial dysfunction after myocardial infarction (MI). However, the correlation between left ventricular (LV) strain (including regional and global strain) obtained by cardiac magnetic resonance (CMR) imaging and left ventricular thrombus (LVT) after ST-segment elevation myocardial infarction (STEMI) is unclear. METHODS The retrospective clinical observation study included patients with LVT (n = 20) and non-LVT (n = 195) who underwent CMR within two weeks after STEMI. CMR images were analyzed using CVI 42 (Circle Cardiovascular Imaging, Canada) to obtain LV strain values. Logistic regression analysis identified risk factors for LVT among baseline characteristics, CMR ventricular strain, and left ventricular ejection fraction (LVEF). Considering potential correlations between strains, the ability of LV strain to identify LVT was evaluated using 9 distinct models. Receiver operating characteristic curves were generated with GraphPad Prism, and the area under the curve (AUC) of LVEF, apical longitudinal strain (LS), and circumferential strain (CS) was calculated to determine their capacity to distinguish LVT. RESULTS Among 215 patients, 9.3% developed LVT, with a 14.5% incidence in those with anterior MI. Univariate regression indicated associations of LAD infarct-related artery, lower NT-proBNP, lower LVEF, and reduced global, midventricular, and apical strain with LVT. Further multivariable regression analysis showed that apical LS, LVEF and NT-proBNP were still independently related to LVT (Apical LS: OR = 1.14, 95%CI (1.01, 1.30), P = 0.042; LVEF: OR = 0.91, 95%CI (0.85, 0.97), P = 0.005; NT-proBNP: OR = 2.35, 95%CI (1.04, 5.31) ). CONCLUSION Reduced apical LS on CMR is independently associated with LVT after STEMI.
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Affiliation(s)
- Qing Chen
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, 99#, Huaihai West Road, Xuzhou, 221002, China
| | - Zeqing Zhang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, 99#, Huaihai West Road, Xuzhou, 221002, China
| | - Lei Chen
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ziyu Zhou
- School of Medical Information and Engineering, Xuzhou Medical University, Xuzhou, China
| | - Yuan Lu
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, 99#, Huaihai West Road, Xuzhou, 221002, China
| | - Chaoqun Zhang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, 99#, Huaihai West Road, Xuzhou, 221002, China
| | - Chengzong Li
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, 99#, Huaihai West Road, Xuzhou, 221002, China
| | - Zhuoqi Zhang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, 99#, Huaihai West Road, Xuzhou, 221002, China.
| | - Wensu Chen
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, 99#, Huaihai West Road, Xuzhou, 221002, China.
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Xu K, Ma Z, Li B, Wang Z, Song H, Bai X, Meng X, Liu K, Zhao X. Totally thoracoscopic surgical resection of left ventricular benign tumor. JTCVS Tech 2023; 20:116-122. [PMID: 37555023 PMCID: PMC10405254 DOI: 10.1016/j.xjtc.2023.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 08/10/2023] Open
Abstract
OBJECTIVE The study objective was to explore the feasibility and safety of totally endoscopic resection of a left ventricular tumor through small chest incisions without robotic assistance. METHODS Four patients with a left ventricular tumor (1 papillary fibroelastoma, 1 lipoma, and 2 myxomas) underwent surgery with peripheral cardiopulmonary bypass. The mean age of patients was 58 ± 15 years. There were 3 female patients and 1 male patient. Through 3-port incisions in the right chest, pericardiotomy, bicaval cannulation, cardiac arrest, and atriotomy, left ventricular tumor resection was performed under thoracoscopy. RESULTS All patients had successful resections. The cardiopulmonary bypass and aortic crossclamp times were 110 ± 14 minutes and 58 ± 19 minutes, respectively. The length of stay in the intensive care unit was 38 ± 27 hours. There were no mortalities or complications in this cohort. Patients were discharged 7 days after the operation. Transthoracic echocardiography showed that the cardiac tumor was completely removed without any residue 3 months after surgery. CONCLUSIONS Totally endoscopic left ventricular tumor resection without a robotically assisted surgical system is feasible and reproducible. This technique could minimize surgical trauma and achieves complete tumor resection.
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Affiliation(s)
- Kai Xu
- Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, Shandong, China
- Institute of Thoracoscopy in Cardiac Surgery, Shandong University, Shandong, China
| | - Zengshan Ma
- Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, Shandong, China
- Institute of Thoracoscopy in Cardiac Surgery, Shandong University, Shandong, China
| | - Bowen Li
- Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, Shandong, China
- Institute of Thoracoscopy in Cardiac Surgery, Shandong University, Shandong, China
| | - Zhenhua Wang
- Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, Shandong, China
- Institute of Thoracoscopy in Cardiac Surgery, Shandong University, Shandong, China
| | - Han Song
- Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, Shandong, China
- Institute of Thoracoscopy in Cardiac Surgery, Shandong University, Shandong, China
| | - Xiao Bai
- Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, Shandong, China
- Institute of Thoracoscopy in Cardiac Surgery, Shandong University, Shandong, China
| | - Xiangbin Meng
- Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, Shandong, China
- Institute of Thoracoscopy in Cardiac Surgery, Shandong University, Shandong, China
| | - Kai Liu
- Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, Shandong, China
- Institute of Thoracoscopy in Cardiac Surgery, Shandong University, Shandong, China
| | - Xin Zhao
- Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, Shandong, China
- Institute of Thoracoscopy in Cardiac Surgery, Shandong University, Shandong, China
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Zhang Q, Zhang Z, Zheng H, Wang C, Yu M, Si D, Zhang W. Clinical profile and prognosis of elderly patients with left ventricular thrombus after anticoagulation. Thromb J 2023; 21:75. [PMID: 37430265 PMCID: PMC10332057 DOI: 10.1186/s12959-023-00520-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/01/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Contemporary data regarding the clinical characteristics and prognosis of left ventricular thrombus (LVT) in older adults (aged ≥ 65 years old) are lacking. In this study, we characterized elderly patients with LVT (aged ≥ 65 years old) and investigated the long-term prognosis in this highly vulnerable patient population. METHODS This single-center, retrospective study was conducted from January 2017 to December 2022. Patients with a reported LVT were assessed primarily by transthoracic echocardiography (TEE) and classified into two groups: elderly LVT groups and younger LVT groups. All patients were treated with anticoagulant treatment. Major adverse cardiovascular event (MACE) was defined as the composite of all-cause mortality, systemic embolism, and rehospitalization for cardiovascular events. Survival analyses were performed with the Kaplan-Meier method and Cox proportional-hazard model. RESULTS A total of 315 eligible patients were included. Compared to the younger LVT group (n = 171), the elderly LVT group (n = 144) had a lower proportion of males and lower serum creatinine clearance, as well as a higher level of NT-proBNP, and a higher rate of history of systemic embolism. LVT resolution occurred in 59.7% and 69.0% of patients in the elderly LVT group and younger LVT group, respectively, with no significant difference (adjusted HR, 0.97; 95% CI, 0.74-1.28; P = 0.836). Yet, elderly patients with LVT, had higher prevalence rates of MACE (adjusted HR, 1.52; 95% CI, 1.10-2.11; P = 0.012), systemic embolism (adjusted HR, 2.81; 95% CI, 1.20-6.59; P = 0.017) and all-cause mortality (adjusted HR, 2.20; 95% CI, 1.29-3.74; P = 0.004) compared with younger patients with LVT. After adjusting for mortality in the Fine-Gray model, similar results were observed. Additionally, patients treated with different anticoagulation therapies (DOACs vs. warfarin) achieved a similar improvement in prognosis (P > 0.05) or LVT resolution (P > 0.05) in elderly patients with LVT. CONCLUSIONS Our results found that elderly patients experiencing LVT have a poor prognosis compared with the younger ones. Clinical prognosis in elderly patients did not significantly differ with the type of anticoagulant used. With aging societies worldwide, further evidence of antithrombotic therapy in elderly individuals with LVT is necessary.
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Affiliation(s)
- Qian Zhang
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Jilin Provincial Molecular Biology Research Center for Precision Medicine of Major Cardiovascular Disease, Xiantai Street NO. 126, 130000, Changchun, Jilin, China
| | - Zhongfan Zhang
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Jilin Provincial Molecular Biology Research Center for Precision Medicine of Major Cardiovascular Disease, Xiantai Street NO. 126, 130000, Changchun, Jilin, China
| | - Haikuo Zheng
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Jilin Provincial Molecular Biology Research Center for Precision Medicine of Major Cardiovascular Disease, Xiantai Street NO. 126, 130000, Changchun, Jilin, China
| | - Chengbing Wang
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, Changchun, Jilin, China
| | - Miao Yu
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Jilin Provincial Molecular Biology Research Center for Precision Medicine of Major Cardiovascular Disease, Xiantai Street NO. 126, 130000, Changchun, Jilin, China
| | - Daoyuan Si
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Jilin Provincial Molecular Biology Research Center for Precision Medicine of Major Cardiovascular Disease, Xiantai Street NO. 126, 130000, Changchun, Jilin, China.
| | - Wenqi Zhang
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Jilin Provincial Molecular Biology Research Center for Precision Medicine of Major Cardiovascular Disease, Xiantai Street NO. 126, 130000, Changchun, Jilin, China.
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Allard L, Bernhard B, Windecker S, Valgimigli M, Gräni C. Left ventricular thrombus in ischaemic heart disease: diagnosis, treatment, and gaps of knowledge. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2022; 8:496-509. [PMID: 34928322 DOI: 10.1093/ehjqcco/qcab097] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/14/2021] [Accepted: 12/16/2021] [Indexed: 12/29/2022]
Abstract
Although the management of ischaemic heart disease has markedly improved over the last decades, left ventricular thrombus remains a serious finding in patients with myocardial infarction. Routine diagnostic detection of left ventricular thrombus relies mainly on echocardiography; however, cardiac magnetic resonance has emerged as a method with higher diagnostic accuracy, while cardiac computed tomography angiography represents a valuable alternative modality. To reduce the left ventricular thrombus-associated morbidity and mortality, optimal selection of anticoagulation is warranted after balancing the risk of bleeding. In this review, we will discuss contemporary diagnostic modalities to detect left ventricular thrombus in ischaemic heart disease and summarize evidence on risk stratification and therapy. In addition, we propose a novel diagnosis, follow-up imaging, and treatment algorithm. Further, we identify knowledge gaps at different levels to address emerging research questions and to refine the design of future studies aiming to improve the management of patients in this clinical setting.
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Affiliation(s)
- Ludovic Allard
- Department of Cardiology, University Hospital of Bern, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Benedikt Bernhard
- Department of Cardiology, University Hospital of Bern, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, University Hospital of Bern, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Marco Valgimigli
- Department of Cardiology, University Hospital of Bern, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.,Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale and Department of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland
| | - Christoph Gräni
- Department of Cardiology, University Hospital of Bern, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
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Zhang Q, Si D, Zhang Z, Zhang W. Loeffler endocarditis with intracardiac thrombus: case report and literature review. BMC Cardiovasc Disord 2021; 21:615. [PMID: 34961478 PMCID: PMC8713406 DOI: 10.1186/s12872-021-02443-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 12/21/2021] [Indexed: 12/24/2022] Open
Abstract
Background Loeffler endocarditis is a relatively rare and potentially life-threatening heart disease. This study aimed to identify the characteristic features of Loeffler endocarditis with intracardiac thrombus on a background of hypereosinophilic syndrome (HES). Case presentation We described a 57-year-old woman with Loeffler endocarditis and intracardiac thrombus initially presenting with neurological symptoms, who had an embolic stroke in the setting of HES. After cardiac magnetic resonance (CMR), corticosteroids and warfarin were administered to control eosinophilia and thrombi, respectively. During a 10-month follow-up, the patient performed relatively well, with no adverse events. We also systematically searched PubMed and Embase for cases of Loeffler endocarditis with intracardiac thrombus published until July 2021. A total of 32 studies were eligible and included in our analysis. Further, 36.4% of recruited patients developed thromboembolic complications, and the mortality rate was relatively high (27.3%). CMR was a powerful noninvasive modality in providing diagnostic and follow-up information in these patients. Steroids were administered in 81.8% of patients, achieving a rapid decrease in the eosinophil count. Also, 69.7% of patients were treated with anticoagulant therapy, and the thrombus was completely resolved in 42.4% of patients. Heart failure and patients not treated with anticoagulation were associated with poor outcomes. Conclusions Cardiac involvement in HES, especially Loeffler endocarditis with intracardiac thrombus, carries a pessimistic prognosis and significant mortality. Early steroids and anticoagulation therapy may be beneficial once a working diagnosis is established. Further studies are needed to provide evidence-based evidence for managing this uncommon manifestation of HES.
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Affiliation(s)
- Qian Zhang
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Xiantai Street No. 126, Changchun, Jilin, China
| | - Daoyuan Si
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Xiantai Street No. 126, Changchun, Jilin, China
| | - Zhongfan Zhang
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Xiantai Street No. 126, Changchun, Jilin, China
| | - Wenqi Zhang
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Xiantai Street No. 126, Changchun, Jilin, China.
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Zhang Q, Zhang Z, Jin L, Wang C, Zheng H, Li S, Yu M, Si D, Zhang W. Prognosis and New Predictors of Early Left-Ventricular Thrombus Following ST-Elevation Myocardial Infarction. Int J Gen Med 2021; 14:8991-9000. [PMID: 34876837 PMCID: PMC8643177 DOI: 10.2147/ijgm.s343418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/17/2021] [Indexed: 12/03/2022] Open
Abstract
Objective In the current era of primary percutaneous coronary intervention (PPCI), the prognosis of the left ventricular thrombus (LVT) is not well assessed. Methods We performed a retrospective, single-center study of 1305 consecutive ST-segment-elevation myocardial infarction (STEMI) patients treated with PPCI. During a mean period of 27 months of follow-up, the major adverse cardiovascular and cerebrovascular events (MACCE) were recorded. Results The incidence of LVT (n = 47) was 3.60%. The independent risk factors of LVT included anterior STEMI, left ventricular (LV) aneurysm, reduced LV ejection fraction (LVEF), dilated LV end-diastolic dimension (LVEDD), and delayed door-to-balloon time (DTBT). During follow-up, LVT was an independent risk factor for MACCE [hazard ratio (HR)=3.46; 95% confidence interval (CI) = 2.23–3.38; P < 0.01]. Patients with LVT were more likely to have the following complications: heart failure (P < 0.001), embolic events (P = 0.034), and all-cause mortality (P = 0.020). Notably, the regression of LVT was not independently associated with those three adverse events (P > 0.05). Conclusion In the era of PPCI, the presence of early LVT following STEMI was associated with adverse events. Furthermore, the prognosis of patients with LVT did not improve even if the LVT regressed. LVT was likely a generalized indicator of impaired cardiac performance, rather than the cause. This indicated that prophylactic therapy and identifying individuals with a high risk of developing LVT were of substantial importance.
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Affiliation(s)
- Qian Zhang
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Jilin Provincial Molecular Biology Research Center for Precision Medicine of Major Cardiovascular Disease, Changchun, People's Republic of China
| | - Zhongfan Zhang
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Jilin Provincial Molecular Biology Research Center for Precision Medicine of Major Cardiovascular Disease, Changchun, People's Republic of China
| | - Lina Jin
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, People's Republic of China
| | - Chengbing Wang
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, People's Republic of China
| | - Haikuo Zheng
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Jilin Provincial Molecular Biology Research Center for Precision Medicine of Major Cardiovascular Disease, Changchun, People's Republic of China
| | - Shouping Li
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Jilin Provincial Molecular Biology Research Center for Precision Medicine of Major Cardiovascular Disease, Changchun, People's Republic of China
| | - Miao Yu
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Jilin Provincial Molecular Biology Research Center for Precision Medicine of Major Cardiovascular Disease, Changchun, People's Republic of China
| | - Daoyuan Si
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Jilin Provincial Molecular Biology Research Center for Precision Medicine of Major Cardiovascular Disease, Changchun, People's Republic of China
| | - Wenqi Zhang
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Jilin Provincial Molecular Biology Research Center for Precision Medicine of Major Cardiovascular Disease, Changchun, People's Republic of China
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Tan S, Thakur U, Chow KY, Lee S, Ngoi A, Nerlekar N, Nasis A. Predictive utility of left heart catheterization indices for left ventricular thrombus formation after anterior ST-elevation myocardial infarction. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 34:106-111. [PMID: 33461935 DOI: 10.1016/j.carrev.2021.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 12/22/2020] [Accepted: 01/12/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND Left ventricular thrombus (LVT) has a 5% incidence after anterior ST-elevation myocardial infarction (STEMI). Multiple risk factors predispose to LVT formation, including left ventricular systolic dysfunction and infarct size, however measurable predictors during index left heart catheterization (LHC) have not been determined. METHODS We performed a retrospective analysis of patients presenting between January 2010 and September 2017 with anterior STEMI who had in-hospital transthoracic echocardiography (TTE). LHC variables that were assessed included coronary anatomy, location of culprit stenosis, presence of diffuse stenosis, number of severely diseased vessels, apical akinesis on left ventriculogram (LVG), left ventricular end diastolic pressure, and success of percutaneous coronary intervention (PCI). RESULTS Of 598 consecutive anterior STEMI patients, records and inpatient TTE results were available in 425 patients. The incidence of LVT was 6.8% (n = 29). After multivariate adjustment, severe triple vessel coronary disease (OR = 8.27, CI = 2.97-23.00, p ≤0.001), apical akinesis on LVG (OR = 6.74, CI = 1.48-30.73, p = 0.014), wrap-around left anterior descending (LAD) anatomy (OR = 5.10, CI = 1.97-13.23, p = 0.001), and failure of recanalization after PCI (OR = 3.94, CI = 1.06-14.66, p = 0.04) were predictors for LVT formation. The combined negative predictive value (NPV) for the absence of these four indices was 99.2%. CONCLUSION Severe triple vessel disease, apical akinesis on LVG during index admission, wrap-around LAD, and failure of recanalization after PCI are associated with increased risk of LVT formation after anterior STEMI. The high NPV for the absence of these indices could serve as a risk stratification tool for LVT risk to guide early TTE utilization.
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Affiliation(s)
- Sean Tan
- MonashHeart, Monash Health, 246 Clayton Road, Clayton, Victoria 3168, Australia.
| | - Udit Thakur
- MonashHeart, Monash Health, 246 Clayton Road, Clayton, Victoria 3168, Australia
| | - Kuan Yee Chow
- Ballarat Health Services, 1 Drummond Street North, Ballarat, Victoria 3350, Australia
| | - Senhong Lee
- Monash Health, 246 Clayton Road, Clayton, Victoria 3168, Australia
| | - Andy Ngoi
- Monash Health, 246 Clayton Road, Clayton, Victoria 3168, Australia
| | - Nitesh Nerlekar
- MonashHeart, Monash Health, 246 Clayton Road, Clayton, Victoria 3168, Australia; Monash University, Wellington Road, Clayton, Victoria 3800, Australia
| | - Arthur Nasis
- MonashHeart, Monash Health, 246 Clayton Road, Clayton, Victoria 3168, Australia; Monash University, Wellington Road, Clayton, Victoria 3800, Australia.
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9
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Low CJ, Leow AST, Syn NLX, Tan BYQ, Yeo LLL, Tay ELW, Yeo TC, Chan MYY, Loh JPY, Sia CH. Outcomes of left ventricular thrombosis in post-acute myocardial infarction patients stratified by antithrombotic strategies: A meta-analysis with meta-regression. Int J Cardiol 2021; 329:36-45. [PMID: 33412177 DOI: 10.1016/j.ijcard.2020.12.087] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 12/08/2020] [Accepted: 12/28/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Left ventricular thrombus (LVT) formation is a significant complication of acute myocardial infarction (AMI) due to its embolic potential. However, managing LVT requires balancing therapeutic benefits against bleeding risks. Our study provides a risk-benefit analysis of various antithrombotic regimens on long-term outcomes in treating post-AMI LVT patients. METHODS We conducted a comprehensive literature search in Medline, Embase and SCOPUS up to 1 April 2020. All studies reporting outcomes of post-AMI LVT patients were included. RESULTS 17 studies were included in total. Anticoagulation (47-100%) and triple therapy use (38-100%) varied largely across studies. On meta-analysis, administration of anticoagulation (OR 0.14, 95% CI 0.05-0.36, p < 0.001) and triple therapy (OR 0.22, 95% CI 0.07-0.66, p < 0.001) resulted in lower odds of mortality. Neither anticoagulation (p = 0.24) nor triple therapy (p = 0.73) was associated with bleeding. Triple therapy was associated with LVT resolution on meta-analysis (OR 2.53, 95% CI 1.53-4.19, p < 0.001) and regression analysis (OR 1.28, 95% CI 1.03-1.58, p = 0.03). Anticoagulation and triple therapy were independent predictors of systemic embolism ([OR 0.67, 95% CI 0.49-0.93, p = 0.02] and [OR 0.82, 95% CI 0.73-0.93, p = 0.001]) and stroke ([OR 0.62, 95% CI 0.41-0.94, p = 0.03] and [OR 0.73, 95% CI 0.55-0.96, p = 0.03]). CONCLUSIONS While there is clear therapeutic benefit in anticoagulation for post-AMI LVT, the extent of bleeding risk is uncertain. Future trials are necessary to determine the optimal antithrombotic strategy for post-AMI LVT management.
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Affiliation(s)
| | | | - Nicholas Li-Xun Syn
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Leonard Leong-Litt Yeo
- Division of Neurology, Department of Medicine, National University Health System, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Edgar Lik-Wui Tay
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre, Singapore
| | - Tiong-Cheng Yeo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre, Singapore
| | - Mark Yan-Yee Chan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre, Singapore
| | - Joshua Ping-Yun Loh
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre, Singapore
| | - Ching-Hui Sia
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre, Singapore.
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Zhou K, Zhang X, Xiao Y, Li D, Song G. Effectiveness and safety of direct-acting oral anticoagulants compared to vitamin K antagonists in patients with left ventricular thrombus: A meta-analysis. Thromb Res 2020; 197:185-191. [PMID: 33227655 DOI: 10.1016/j.thromres.2020.11.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/27/2020] [Accepted: 11/13/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Left ventricular thrombus (LVT) is a complication of multiple cardiovascular diseases. There has been an increasing trend of off-label using direct-acting oral anticoagulants (DOACs) for the treatment of patients with LVT. The effectiveness and safety of DOACs remain to be determined. METHOD We searched for publications (PubMed, MEDLINE, Web of Science, EMBASE, Scopus, and ClinicalTrials.gov) comparing DOACs with Vitamin K antagonists (VKAs) in patients with LVT. We estimated odds ratio (OR) and 95% confidence intervals (CIs) for stroke, systemic embolism, major bleeding events, and thrombus resolution as the effectiveness and safety outcomes. The subgroup analysis and meta-regression were also performed. RESULTS Nine retrospective observational studies with a total of 2028 participants were included. DOACs demonstrated a similar risk of stroke, systemic embolism, major bleeding events, and thrombus resolution (OR = 0.79, 95% CI: 0.50-1.23; OR = 1.22, 95% CI: 0.65-2.26; OR = 0.82, 95% CI: 0.47-1.42; OR = 1.34, 95% CI: 0.62-2.90, respectively). CONCLUSIONS There is no difference between DOACs and VKAs in patients with LVT from the perspectives of stroke, systemic embolism, major bleeding events, and thrombus resolution. Prospective randomized controlled trials with adequate sample sizes are urgently needed to confirm findings.
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Affiliation(s)
- Ke Zhou
- Department of Cardiac Surgery, Shengjing Hospital of China Medical University, Shenyang, China.
| | - Xintong Zhang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yangjie Xiao
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Dongyu Li
- Department of Cardiac Surgery, Shengjing Hospital of China Medical University, Shenyang, China.
| | - Guang Song
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China.
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11
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Zhang Q, Si D, Zhang Z, Wang C, Zheng H, Li S, Huang S, Zhang W. Value of the platelet-to-lymphocyte ratio in the prediction of left ventricular thrombus in anterior ST-elevation myocardial infarction with left ventricular dysfunction. BMC Cardiovasc Disord 2020; 20:428. [PMID: 32993501 PMCID: PMC7526106 DOI: 10.1186/s12872-020-01712-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 09/22/2020] [Indexed: 12/23/2022] Open
Abstract
Background The predictors of left ventricular thrombus (LVT) formation are not well defined in the contemporary era, especially in those patients at high risk. We aimed to evaluate whether the platelet/lymphocyte ratio (PLR) is valuable in the determination of LVT formation in patients with anterior ST-elevation myocardial infarction (STEMI) and left ventricular (LV) dysfunction. Methods The LVT group (n = 46) was identified from anterior STEMI patients with LV dysfunction who were treated with primary percutaneous coronary intervention (PCI) from January 2017 to December 2019 at the China-Japan Union Hospital of Jilin University. The no-LVT group (n = 92) were also selected from the same batch of patients and were age- and sex-matched to the patients with LVT. The PLR was determined at admission and was calculated as the ratio of the platelet count to the lymphocyte count using the complete blood count. The presence of LVT was determined by echocardiography. Results The PLR were significantly higher in patients with LVT than in no-LVT group (p = 0.001). In a receiver operator characteristic curve (ROC) analysis, using a cut-off value of 118.07 (AUC 0.673, 95% CI: 0.574–0.771, P = 0.001), the PLR could independently predict the occurrence of LVT. Multivariate analysis showed that an increased PLR (OR = 1.011, 95% CI: 1.004–1.018, P = 0.002), the presence of a left ventricular aneurysm (OR = 46.350, 95% CI: 5.659–379.615, P < 0.001) and increased DTBT (OR = 1.005, 95% CI: 1.001–1.009, P = 0.012) were independent predictors of LVT formation. Conclusions In acute anterior STEMI patients with LV dysfunction, an increased PLR and DTBT and the presence of an LV aneurysm were independent predictors of LVT formation. A larger prospective study is warranted to evaluate this result. Trial registration This study was registered (May 4, 2019) on Chinese Clinical Trial Registry (ChiCTR-DDD-17011214).
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Affiliation(s)
- Qian Zhang
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Xiantai Street NO.126, Changchun, Jilin, China
| | - Daoyuan Si
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Xiantai Street NO.126, Changchun, Jilin, China
| | - Zhongfan Zhang
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Xiantai Street NO.126, Changchun, Jilin, China
| | - Chengbing Wang
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Haikuo Zheng
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Xiantai Street NO.126, Changchun, Jilin, China
| | - Shouping Li
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Xiantai Street NO.126, Changchun, Jilin, China
| | - Shijian Huang
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Xiantai Street NO.126, Changchun, Jilin, China
| | - Wenqi Zhang
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Xiantai Street NO.126, Changchun, Jilin, China.
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12
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Chen PF, Yi JL, Pei JY, Tang L, Fang ZF, Zhou SH, Hu XQ. Post-Procedural Anticoagulation After Primary Percutaneous Coronary Intervention for Anterior Acute Myocardial Infarction With Severe Left Ventricular Dysfunction. Circ J 2020; 84:1728-1733. [PMID: 32848114 DOI: 10.1253/circj.cj-19-1192] [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] [Indexed: 11/09/2022]
Abstract
BACKGROUND Patients with anterior acute myocardial infarction (AMI) and left ventricular (LV) dysfunction have an increased risk of LV thrombus (LVT). In the thrombolytic era, short-term anticoagulation using low-molecular-weight heparin during hospitalization proved to significantly reduce LVT formation, but, the effect of this prophylactic approach remains unclear in the current era. Therefore, we conducted a study to evaluate the effects of post-procedural anticoagulation (PPAC) using enoxaparin in addition to dual antiplatelet therapy (DAPT) after primary percutaneous coronary intervention (PCI) in such patients.Methods and Results:A total of 426 anterior AMI patients with LV ejection fraction ≤40% were retrospectively enrolled and classified into 2 groups based on whether they received PPAC (enoxaparin SC for at least 7 days). All patients received primary PCI and DAPT. The primary endpoint was definite LVT at 30 days diagnosed by echocardiography. The secondary endpoints were 30-day mortality, embolic events, and major bleeding events. PPAC was independently associated with a lower incidence of LVT (odds ratio 0.139, 95% confidence interval 0.032-0.606, P=0.009). The 30-day mortality, embolic events, and major bleeding events were not statistically different between groups. CONCLUSIONS Short-term PPAC using enoxaparin after primary PCI may be an effective and safe way to prevent LVT in patients with anterior AMI and LV dysfunction.
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Affiliation(s)
- Peng-Fei Chen
- Department of Cardiology, The Second Xiangya Hospital of Central South University
| | - Jun-Lin Yi
- Department of Cardiology, The Second Xiangya Hospital of Central South University
| | - Jun-Yu Pei
- Department of Cardiology, The Second Xiangya Hospital of Central South University
| | - Liang Tang
- Department of Cardiology, The Second Xiangya Hospital of Central South University
| | - Zhen-Fei Fang
- Department of Cardiology, The Second Xiangya Hospital of Central South University
| | - Sheng-Hua Zhou
- Department of Cardiology, The Second Xiangya Hospital of Central South University
| | - Xin-Qun Hu
- Department of Cardiology, The Second Xiangya Hospital of Central South University
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13
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Barbieri A, Mantovani F, Bursi F, Faggiano A, Boriani G, Faggiano P. Optimal Use of Echocardiography in Management of Thrombosis After Anterior Myocardial Infarction. Echocardiography 2020; 37:1287-1295. [DOI: 10.1111/echo.14808] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/09/2020] [Accepted: 07/16/2020] [Indexed: 01/18/2023] Open
Affiliation(s)
- Andrea Barbieri
- Department of Cardiology Azienda Ospedaliera‐Universitaria di Modena Modena Italy
| | - Francesca Mantovani
- Department of Cardiology Azienda Unità Sanitaria Locale ‐ IRCCS di Reggio Emilia Reggio Emilia Italy
| | - Francesca Bursi
- Department of Cardiology Division of Cardiology, Heart and Lung Department San Paolo Hospital, ASST Santi Paolo and Carlo University of Milan Milano Italy
| | | | - Giuseppe Boriani
- Department of Cardiology Azienda Ospedaliera‐Universitaria di Modena Modena Italy
| | - Pompilio Faggiano
- Cardiology Division Spedali Civili and University of Brescia Brescia Italy
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He J, Ge H, Dong JX, Zhang W, Kong LC, Qiao ZQ, Zheng Y, Ding S, Wan F, Shen L, Wang W, Gu ZC, Yang F, Li Z, Pu J. Rationale and design of a prospective multi-center randomized trial of EARLY treatment by rivaroxaban versus warfarin in ST-segment elevation MYOcardial infarction with Left Ventricular Thrombus (EARLY-MYO-LVT trial). ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:392. [PMID: 32355836 PMCID: PMC7186620 DOI: 10.21037/atm.2020.02.117] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background Left ventricular thrombus (LVT), a common complication of acute ST-segment elevation myocardial infarction (STEMI), is associated with increased risk of systemic embolism and high mortality. Current STEMI guidelines recommend adding anticoagulant therapy to dual antiplatelet therapy (DAPT) if early-formulated LVT were detected, for which vitamin K antagonist (VKA) is the standard anticoagulant agent. The role of non-VKA oral anticoagulants (NOACs) in this scenario is uncertain. Methods The EARLY-MYO-LVT study will be a prospective, multi-center and randomized trial designed to investigate the efficacy and safety of rivaroxaban versus warfarin in the treatment of post-STEMI LVT. It will enroll 280 patients with STEMI who have developed LVT within the first month of symptom onset. They will be randomized at 1:1 ratio into the group of rivaroxaban 15 mg daily or VKA treatment (with targeted INR 2–2.5) on the basis of standard DAPT (100 mg daily aspirin plus 75 mg daily clopidogrel) for 3–6 months. The primary efficacy endpoint will be the probability of LVT resolution after 3-month triple therapy, and the principal safety outcome will be the incidence of major bleeding events during the treatment. Discussion The described study will systemically assess the efficacy and safety of NOACs-based anticoagulant therapy in the treatment of LVT subsequent to STEMI. Trial registration The EARLY-MYO-LVT trial (Clinical trial number: NCT03764241).
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Affiliation(s)
- Jie He
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 200127 Shanghai, China
| | - Heng Ge
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 200127 Shanghai, China
| | - Jian-Xun Dong
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 200127 Shanghai, China
| | - Wei Zhang
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 200127 Shanghai, China
| | - Ling-Cong Kong
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 200127 Shanghai, China
| | - Zhi-Qing Qiao
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 200127 Shanghai, China
| | - Ying Zheng
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 200127 Shanghai, China
| | - Song Ding
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 200127 Shanghai, China
| | - Fang Wan
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 200127 Shanghai, China
| | - Long Shen
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 200127 Shanghai, China
| | - Wei Wang
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 200127 Shanghai, China
| | - Zhi-Chun Gu
- Department of Pharmacy, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 200127 Shanghai, China
| | - Fan Yang
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 200127 Shanghai, China
| | - Zheng Li
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 200127 Shanghai, China
| | - Jun Pu
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 200127 Shanghai, China
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