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Colle B, Demeure F, Higny J, Benoit M, Henry JP, Michaux I, Robaye B, Xhaët O, Gabriel L, Guedes A, Blommaert D, Dulieu N, Berners Y, Wery F, Droogmans S, Cosyns B, Luchian ML. Emerging Trends in Left Ventricular Thrombus: A Comprehensive Review of Non-Ischemic and Ischemic Cardiopathies, Including Eosinophilic Myocarditis, Chagas Cardiomyopathy, Amyloidosis, and Innovative Anticoagulant Approaches. Diagnostics (Basel) 2024; 14:948. [PMID: 38732361 PMCID: PMC11083388 DOI: 10.3390/diagnostics14090948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 04/25/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
This comprehensive review explores the intricate aspects of left ventricular thrombus (LVT), a potential complication in both ischemic and non-ischemic cardiomyopathies. It provides a thorough understanding of left ventricular thrombus, revealing its uncommon incidence in the general population (7 cases per 10,000 patients), predominantly linked to ischemic heart diseases (ICMs) at an 80% prevalence rate. Diagnostic tools, notably transthoracic echocardiography (TTE) and cardiac magnetic resonance imaging (CMR), demonstrate varying sensitivity but remain indispensable in specific clinical contexts related to LVT as non-invasive diagnostic modalities. A detailed comparison between ICM patients and those with non-ischemic cardiomyopathy (NICM) who have left ventricular thrombus reveals subtle distinctions with significant clinical implications. This analysis underscores the importance of these imaging techniques in distinguishing between the two conditions. Additionally, we explored the occurrence of LVT in specific non-ischemic cardiomyopathies, including Takotsubo syndrome, hypertrophic cardiomyopathy, eosinophilic myocarditis, Chagas disease, cardiac amyloidosis, and several other conditions. The article further delves into anticoagulation strategies, thoroughly examining their impact on LVT regression and patient outcomes. Pharmacological interventions, with a focus on direct oral anticoagulants, emerge as promising alternatives; however, there is insufficient information on their efficiency and safety, especially in NICM population. In conclusion, this review highlights the complex nature of LVT, incorporating a range of etiopathogenic factors, diagnostic complexities, and evolving therapeutic approaches. It emphasizes the pressing need for ongoing research in this field.
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Affiliation(s)
- Benjamin Colle
- Department of Cardiology, Université Catholique de Louvain (UCL), CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium
| | - Fabian Demeure
- Department of Cardiology, Université Catholique de Louvain (UCL), CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium
| | - Julien Higny
- Department of Cardiology, Université Catholique de Louvain (UCL), CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium
| | - Martin Benoit
- Department of Cardiology, Université Catholique de Louvain (UCL), CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium
| | - Jean-Philippe Henry
- Department of Cardiology, Université Catholique de Louvain (UCL), CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium
| | - Isabelle Michaux
- Department of Intensive Care, Université Catholique de Louvain (UCL), CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium
| | - Benoit Robaye
- Department of Cardiology, Université Catholique de Louvain (UCL), CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium
| | - Olivier Xhaët
- Department of Cardiology, Université Catholique de Louvain (UCL), CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium
| | - Laurence Gabriel
- Department of Cardiology, Université Catholique de Louvain (UCL), CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium
| | - Antoine Guedes
- Department of Cardiology, Université Catholique de Louvain (UCL), CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium
| | - Dominique Blommaert
- Department of Cardiology, Université Catholique de Louvain (UCL), CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium
| | - Nathalie Dulieu
- Department of Cardiology, Université Catholique de Louvain (UCL), CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium
| | - Yannick Berners
- Department of Cardiology, Université Catholique de Louvain (UCL), CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium
| | - Fabian Wery
- Department of Cardiology, Université Catholique de Louvain (UCL), CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium
| | - Steven Droogmans
- Department of Cardiology, Centrum voor Hart-en Vaatziekten, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Bernard Cosyns
- Department of Cardiology, Centrum voor Hart-en Vaatziekten, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Maria-Luiza Luchian
- Department of Cardiology, Université Catholique de Louvain (UCL), CHU UCL Namur Site Godinne, Av. Dr. G. Thérasse, 1, 5530 Yvoir, Belgium
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Hu T, Chen C, Maduray K, Han W, Chen T, Zhong J. Comparative effectiveness and safety of DOACs vs. VKAs in treatment of left ventricular thrombus- a meta-analysis update. Thromb J 2024; 22:23. [PMID: 38429631 PMCID: PMC10905864 DOI: 10.1186/s12959-024-00585-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/22/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Left ventricular thrombus (LVT) formation in patients with acute myocardial infarction (AMI) or cardiomyopathies is not uncommon. The optimal oral anticoagulation therapy for resolving LVT has been under intense debate. Vitamin K antagonists (VKAs) remain the anticoagulant of choice for this condition, according to practice guidelines. Evidence supporting the use of direct oral anticoagulants (DOACs) in the management of LVT continues to grow. We performed a systematic review and meta-analysis to compare the efficacy and safety of DOACs versus VKAs. METHODS A comprehensive literature search was carried out in PubMed, Cochrane Library, Web of Science, Embase, and Scopus databases in July 2023. The efficacy outcomes of this study were thrombus resolution, ischemic stroke, systemic embolism, stroke/systemic embolism, all-cause mortality, and adverse cardiovascular events. The safety outcomes were any bleeding, major bleeding, and intracranial hemorrhage. A total of twenty-seven eligible studies were included in the meta-analysis. Data were analyzed utilizing Stata software version 15.1. RESULTS There was no significant difference between DOACs and VKAs with regard to LVT resolution (RR = 1.00, 95% CI 0.95-1.05, P = 0.99). In the overall analysis, DOACs significantly reduced the risk of stroke (RR = 0.74, 95% CI 0.57-0.96, P = 0.021), all-cause mortality (RR = 0.70, 95% CI 0.57-0.86, P = 0.001), any bleeding (RR = 0.75, 95% CI 0.61-0.92, P = 0.006) and major bleeding (RR = 0.67, 95% CI 0.52-0.85, P = 0.001) when compared to VKAs. Meanwhile, in the sub-analysis examining randomized controlled trials (RCTs), the aforementioned outcomes no longer differed significantly between the DOACs and VKAs groups. The incidences of systemic embolism (RR = 0.81, 95% CI 0.54-1.22, P = 0.32), stroke/systemic embolism (RR = 0.85, 95% CI 0.72-1.00, P = 0.056), intracranial hemorrhage (RR = 0.59, 95% CI 0.23-1.54, P = 0.28), and adverse cardiovascular events (RR = 0.99, 95% CI 0.63-1.56, P = 0.92) were comparable between the DOACs and VKAs groups. A subgroup analysis showed that patients treated with rivaroxaban had a significantly lower risk of stroke (RR = 0.24, 95% CI 0.08-0.72, P = 0.011) than those in the VKAs group. CONCLUSION With non-inferior efficacy and superior safety, DOACs are promising therapeutic alternatives to VKAs in the treatment of LVT. Further robust investigations are warranted to confirm our findings.
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Affiliation(s)
- Tong Hu
- National Key Laboratory for Innovation and Transformation of Luobing Theory; The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences; Department of Cardiology, Qilu Hospital of Shandong University, 107 Wen Hua Xi Road, Jinan, 250012, China
| | - Changli Chen
- National Key Laboratory for Innovation and Transformation of Luobing Theory; The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences; Department of Cardiology, Qilu Hospital of Shandong University, 107 Wen Hua Xi Road, Jinan, 250012, China
| | - Kellina Maduray
- National Key Laboratory for Innovation and Transformation of Luobing Theory; The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences; Department of Cardiology, Qilu Hospital of Shandong University, 107 Wen Hua Xi Road, Jinan, 250012, China
| | - Wenqiang Han
- National Key Laboratory for Innovation and Transformation of Luobing Theory; The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences; Department of Cardiology, Qilu Hospital of Shandong University, 107 Wen Hua Xi Road, Jinan, 250012, China
| | - Tongshuai Chen
- National Key Laboratory for Innovation and Transformation of Luobing Theory; The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences; Department of Cardiology, Qilu Hospital of Shandong University, 107 Wen Hua Xi Road, Jinan, 250012, China.
| | - Jingquan Zhong
- National Key Laboratory for Innovation and Transformation of Luobing Theory; The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences; Department of Cardiology, Qilu Hospital of Shandong University, 107 Wen Hua Xi Road, Jinan, 250012, China.
- Department of Cardiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, 758 Hefei Road, Qingdao, 266035, Shandong, China.
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Agrawal A, Bajaj S, Bhagat U, Chandna S, Arockiam AD, Chan N, Haroun E, Gupta R, Badwan O, Shekhar S, Kathavarayan Ramu S, Nayar D, Jaber W, Griffin BP, Wang TKM. Intracardiac Thrombus in COVID-19 Inpatients: A Nationwide Study of Incidence, Predictors, and Outcomes. Angiology 2024:33197231225282. [PMID: 38173053 DOI: 10.1177/00033197231225282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
COronaVIrus Disease-2019 (COVID-19) is associated with a hypercoagulable state. Intracardiac thrombosis is a potentially serious complication but has seldom been evaluated in COVID-19 patients. We assessed the incidence, associated factors, and outcomes of COVID-19 patients with intracardiac thrombosis. In 2020, COVID-19 inpatients were identified from the National Inpatient Sample (NIS) database. Data on clinical characteristics, intracardiac thrombosis, and adverse outcomes were collected. Multivariable logistic regression was used to identify factors associated with intracardiac thrombosis, in-hospital mortality, and morbidities. In 2020, 1,683,785 COVID-19 inpatients (mean age 63.8 years, 32.2% females) were studied. Intracardiac thrombosis occurred in 0.10% (1830) of cases. In-hospital outcomes included 13.2% all-cause mortality, 3.5% cardiovascular mortality, 2.6% cardiac arrest, 4.4% acute coronary syndrome (ACS), 16.1% heart failure, 1.3% stroke, and 28.3% acute kidney injury (AKI). Key factors for intracardiac thrombosis were congestive heart failure history and coagulopathy. Intracardiac thrombosis independently linked to higher risks of all-cause mortality (odds ratio [OR]: 3.32 (2.42-4.54)), cardiovascular mortality (OR: 2.95 (1.96-4.44)), cardiac arrest (OR: 2.04 (1.22-3.43)), ACS (OR: 1.62 (1.17-2.22)), stroke (OR: 3.10 (2.11-4.56)), and AKI (OR: 2.13 (1.68-2.69)), but not heart failure. While rare, intracardiac thrombosis in COVID-19 patients independently raised in-hospital mortality and morbidity risks.
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Affiliation(s)
- Ankit Agrawal
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Suryansh Bajaj
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Umesh Bhagat
- Department of Hospital Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Sanya Chandna
- Department of Hospital Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Aro Daniela Arockiam
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Nicholas Chan
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Elio Haroun
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Rahul Gupta
- Lehigh Valley Heart Institute, Lehigh Valley Health Network, Allentown, PA, USA
| | - Osamah Badwan
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Shashank Shekhar
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Shivabalan Kathavarayan Ramu
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Divya Nayar
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Wael Jaber
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Brian P Griffin
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Tom Kai Ming Wang
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
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He F, Jiao Y, Jiang L. Case report: hunting the hidden: surgical treatment of chronic silent thrombus in the left ventricle in a young alcoholic patient with myocardial bridging. J Cardiothorac Surg 2023; 18:308. [PMID: 37946252 PMCID: PMC10637006 DOI: 10.1186/s13019-023-02414-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 11/03/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND A silent left ventricular thrombus is dangerous. The current standard anticoagulation therapy was ineffective in our case or similar, and the outcome was poor. CASE PRESENTATION A 33-year-old man with a silent left ventricular thrombus was detected incidentally by transthoracic echocardiography. After admission, anti-coagulation with low-molecular-weight heparin therapy was carried out. The CAG revealed 70% systolic stenosis in the middle of the right coronary artery along with myocardial bridging. Unfortunately, an acute left temporal embolism emerged 5 days later, then the patient was transferred to the neurology department for further treatment. One month later, the patient underwent left ventricular thrombectomy, ventricular aneurysm resection, and coronary artery bypass grafting (CABG) and was discharged uneventfully after surgery. CONCLUSIONS Surgical treatment should be a priority for patients with giant or hypermobile left ventricular thrombus or recurrent systemic emboli.
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Affiliation(s)
- Fengpu He
- Department of Cardiovascular Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 67 Qingchun Road, Hangzhou, 310003, Zhejiang, China
| | - Yiping Jiao
- Psychological Teaching and Research Department, Non-commissioned Officer Academy of PAP, Hangzhou, China
| | - Lijun Jiang
- Department of Cardiovascular Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 67 Qingchun Road, Hangzhou, 310003, Zhejiang, China.
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5
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Huang Y, Zhou WW, Li YX, Chen XZ, Gui C. The use of D-dimer in the diagnosis and risk assessment of intracardiac thrombus among patients with dilated cardiomyopathy. Sci Rep 2023; 13:18075. [PMID: 37872215 PMCID: PMC10593857 DOI: 10.1038/s41598-023-45077-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/16/2023] [Indexed: 10/25/2023] Open
Abstract
D-dimer is a biomarker of coagulation and fibrinolytic system activation in response to the body's hypercoagulable state. The study aims to investigate the usefulness of D-dimer in diagnosing and assessing the risk of intracardiac thrombus in patients with dilated cardiomyopathy (DCM). Consecutively enrolled in this study were patients with DCM who were admitted to our center for the first time. The diagnostic value was evaluated using the receiver operating characteristic (ROC) curve. Additionally, we used univariate and multivariate logistic regression to investigate the association between D-dimer and intracardiac thrombus. We also performed smooth curve fitting, threshold saturation effect analysis, and subgroup analysis. In total, 534 patients were enrolled in the study, and among them, 65 patients had intracardiac thrombus. Mural thrombus was the predominant type of thrombus, which was mainly located in the left ventricular apex. The optimal cut-off value of D-dimer for the diagnosis of intracardiac thrombus was 484 ng/mL, with a sensitivity and specificity of 0.769 and 0.646, respectively. In both unadjusted and adjusted logistic regression models, a positive association was found between D-dimer and intracardiac thrombus. Curve fitting and threshold effect analysis revealed two inflection points in the relationship between D-dimer and intracardiac thrombus (non-linear test: P = 0.032). When D-dimer was equal to 362 ng/mL, the odds ratio (OR) was 1, and the risk of thrombus gradually increased until it reached 4096 ng/mL, after which the trend no longer increased. Within this range, a twofold increase in D-dimer was associated with a 103.2% increased risk (OR = 2.032; 95% CI 1.293-3.193; P < 0.01). In the subgroup analysis, there was a significant interaction between D-dimer and BMI on intracardiac thrombus (P value for interaction was 0.013), and the risk was higher in patients with a BMI ≥ 25 kg/m2 (OR = 3.44; 95% CI 1.86-6.36; P < 0.01).
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Affiliation(s)
- Yuan Huang
- Department of Cardiology, Jiangbin Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Wang-Wei Zhou
- Department of Cardiology, Liuzhou People's Hospital, Liuzhou, Guangxi, China
| | - Yu-Xin Li
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, No 6, Shuangyong Road, Nanning, 530021, Guangxi, China
- Guangxi Key Laboratory Base of Precision Medicine in Cardio-Cerebrovascular Diseases Control and Prevention, Nanning, China
- Guangxi Clinical Research Center for Cardio-Cerebrovascular Diseases, Nanning, China
| | - Xiao-Zhen Chen
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, No 6, Shuangyong Road, Nanning, 530021, Guangxi, China
- Guangxi Key Laboratory Base of Precision Medicine in Cardio-Cerebrovascular Diseases Control and Prevention, Nanning, China
- Guangxi Clinical Research Center for Cardio-Cerebrovascular Diseases, Nanning, China
| | - Chun Gui
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, No 6, Shuangyong Road, Nanning, 530021, Guangxi, China.
- Guangxi Key Laboratory Base of Precision Medicine in Cardio-Cerebrovascular Diseases Control and Prevention, Nanning, China.
- Guangxi Clinical Research Center for Cardio-Cerebrovascular Diseases, Nanning, China.
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Honda R, Miyoshi T, Ikeda S, Izutani H, Yamaguchi O. Acute Lymphocytic Myocarditis With Mobile Left Ventricular Thrombus. Cureus 2023; 15:e47262. [PMID: 38022182 PMCID: PMC10655622 DOI: 10.7759/cureus.47262] [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] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
A left ventricular thrombus (LVT) in cardiac disease is associated with various adverse events. To understand the risk of thromboembolism, it is necessary to recognize when LVT is most likely to occur. We present a case of acute lymphocytic myocarditis in a young patient, where the LVT manifestation occurred within 48 hours after the beginning of the disease and was treated by thrombectomy. We have not found any reports of LVT formation earlier than in this case. Patients with acute myocarditis are younger, at a median age of 34 years, and the social impact of embolic complications is considerable. Echocardiography is effective in detecting LVT noninvasively in low- and high-risk patients. Patients with myocarditis can benefit from careful observation by echocardiography.
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Affiliation(s)
- Ryosuke Honda
- Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Toon City, JPN
| | - Toru Miyoshi
- Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Toon City, JPN
| | - Shuntaro Ikeda
- Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Toon City, JPN
| | - Hironori Izutani
- Department of Cardiovascular Surgery, Ehime University Graduate School of Medicine, Toon City, JPN
| | - Osamu Yamaguchi
- Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Toon City, JPN
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Goh FQ, Sia CH, Chan MY, Yeo LL, Tan BY. What's the optimal duration of anticoagulation in patients with left ventricular thrombus? Expert Rev Cardiovasc Ther 2023; 21:947-961. [PMID: 37830297 DOI: 10.1080/14779072.2023.2270906] [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: 07/20/2023] [Accepted: 10/11/2023] [Indexed: 10/14/2023]
Abstract
INTRODUCTION Left ventricular thrombus (LVT) occurs in acute myocardial infarction and in ischemic and non-ischemic cardiomyopathies. LVT may result in embolic stroke. Currently, the duration of anticoagulation for LVT is unclear. This is an important clinical question as prolonged anticoagulation is associated with increased bleeding risks, while premature discontinuation may result in embolic complications. AREAS COVERED There are no randomized trial data regarding anticoagulation duration for LVT. Guidelines and expert consensus recommend anticoagulation for 3-6 months with cessation of anticoagulation if interval imaging demonstrates thrombus resolution. Cardiac magnetic resonance imaging (CMR) is more sensitive and specific compared to echocardiography for LVT detection, and may be appropriate for high-risk patients. Prolonged anticoagulation may be considered in unresolved protuberant or mobile LVT, and in patients with resolved LVT but persistent depressed left ventricular ejection fraction and/or myocardial akinesia or dyskinesia. EXPERT OPINION CMR will likely be increasingly used for LVT surveillance to guide anticoagulation duration. Further research is needed to determine which patients with persistent LVT on CMR benefit from prolonged anticoagulation.
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Affiliation(s)
- Fang Qin Goh
- Department of Medicine, National University Hospital, National University Health System, Singapore
| | - Ching-Hui Sia
- Department of Cardiology, National University Heart Centre Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Mark Y Chan
- Department of Cardiology, National University Heart Centre Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Leonard Ll Yeo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Neurology, Department of Medicine, National University Hospital, Singapore
| | - Benjamin Yq Tan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Neurology, Department of Medicine, National University Hospital, Singapore
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8
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Feldman JM, Frishman WH, Aronow WS. Review of the Etiology, Diagnosis, and Management of Left Ventricular Thrombus. Cardiol Rev 2023; Publish Ahead of Print:00045415-990000000-00114. [PMID: 37326429 DOI: 10.1097/crd.0000000000000572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
The incidence of left ventricular (LV) thrombus following acute myocardial infarction has declined significantly due to recent advancements in reperfusion and antithrombotic therapies. The development of LV thrombus depends on Virchow's triad: endothelial injury following myocardial infarction, blood stasis from LV dysfunction, and hypercoagulability. Diagnostic modalities for LV thrombus include transthoracic echocardiography and late gadolinium enhancement cardiac magnetic resonance imaging. Anticoagulation with direct oral anticoagulants or vitamin K antagonists for 3 months following initial diagnosis of LV thrombus remains the treatment of choice for LV thrombus. However, further evidence is needed to demonstrate the noninferiority of direct oral anticoagulants compared with vitamin K antagonists for the prevention of thromboembolic events.
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Affiliation(s)
- Jared M Feldman
- From the Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - William H Frishman
- From the Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Wilbert S Aronow
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY
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9
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Khan WJ, Asif M, Nadeem I, Moeding M, Baab T, Chowdhury M. Management and Follow-Up of Biventricular Thrombi. Cureus 2023; 15:e39269. [PMID: 37342748 PMCID: PMC10279459 DOI: 10.7759/cureus.39269] [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] [Accepted: 05/20/2023] [Indexed: 06/23/2023] Open
Abstract
A thrombus is the most common intracardiac lesion. Isolated thrombi usually occur in the setting of ventricular dysfunction, such as a dyskinetic or hypokinetic myocardial wall, following an acute myocardial infarction (MI) or in cardiomyopathies (CM). Concurrent biventricular thrombus formation is rare. There are no clear guidelines for the treatment of biventricular thrombus. In this report, we describe our experience of the successful treatment of a case of biventricular thrombus with warfarin and rivaroxaban.
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Affiliation(s)
- Wahab J Khan
- Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, USA
| | - Muhammad Asif
- Internal Medicine, Avera McKennan Hospital and University Health Center, Sioux Falls, USA
| | - Ifrah Nadeem
- Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, USA
| | - Megan Moeding
- Cardiovascular Medicine, North Central Heart Institute, Sioux Falls, USA
| | - Thomas Baab
- Cardiovascular Medicine, North Central Heart Institute, Sioux Falls, USA
| | - Mohammed Chowdhury
- Cardiovascular Medicine, North Central Heart Institute, Sioux Falls, USA
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10
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Dilemmas in hematology: consults in patients with arterial thrombosis. J Thromb Haemost 2023; 21:421-432. [PMID: 36696207 DOI: 10.1016/j.jtha.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/21/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023]
Abstract
Arterial thrombotic events, particularly ischemic stroke and myocardial infarction, are common, and mostly occur due to atherosclerotic disease or arrhythmias. The diagnosis and management of the majority of such events occurs without the involvement of a hematologist, following established guidelines or pathways. In this review, we discuss 3 scenarios in which optimal management is less certain. These scenarios concern patients with a left ventricular thrombus, in whom the duration and choice of anticoagulant has been debated, patients with ischemic stroke and a patent foramen ovale, in whom the role of patent foramen ovale closure requires careful consideration, and the role of thrombophilia testing in young patients after a stroke or myocardial infarction, which remains an area of contention. We consider the available evidence and published guidelines in order to provide a practical, evidence-based approach to these 3 clinical scenarios.
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Suzuki K, Sakamoto SI, Hiromoto A, Motoji Y, Amitani R, Yamaguchi T, Ishii Y. Case of left ventricular thrombus managed with thrombectomy with left ventricular reconstruction in a patient who had coronavirus disease 2019 infection. J Cardiothorac Surg 2023; 18:8. [PMID: 36611152 PMCID: PMC9823256 DOI: 10.1186/s13019-023-02108-5] [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: 03/10/2022] [Accepted: 01/02/2023] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Intracardiac thrombus is relatively rare in patients with coronavirus disease 2019 (COVID-19). However, if it occurs, thrombotic complications are likely to develop. In this case, we performed a successful thrombectomy on a patient who developed left ventricular thrombus after COVID-19 infection without complications. CASE PRESENTATION A 52-year-old man sought medical care due to fever, dyspnea, and abnormalities in the taste and smell that persisted for 2 weeks. The patient was diagnosed with COVID-19 and was treated with remdesivir, baricitinib, and heparin. Three weeks after hospitalization, electrocardiogram revealed angina pectoris, and cardiac catherization showed left anterior descending coronary artery stenosis. In addition, global hypokinesis and a thrombus at the left ventricular apex were observed on echocardiography. Left ventricular reconstruction concomitant with coronary artery bypass grafting was performed. A thrombus in the left ventricle was resected via left apical ventriculotomy, and the bovine pericardium was covered and sutured on the infarction site to exclude it. The patient was extubated a day after surgery and was transferred to another hospital for recuperation after 20 days. He did not present with complications. CONCLUSIONS Thrombotic events could be prevented via thrombectomy with left ventricular reconstruction using an intraventricular patch to exclude the residual thrombus.
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Affiliation(s)
- Kenji Suzuki
- grid.459842.60000 0004 0406 9101Department of Cardiovascular Surgery, Nippon Medical School Musashikosugi Hospital, 1-383 Kosugimachi, Nakahara-Ku, Kawasaki, Kanagawa 211-8533 Japan
| | - Shun-Ichiro Sakamoto
- grid.459842.60000 0004 0406 9101Department of Cardiovascular Surgery, Nippon Medical School Musashikosugi Hospital, 1-383 Kosugimachi, Nakahara-Ku, Kawasaki, Kanagawa 211-8533 Japan
| | - Atsushi Hiromoto
- grid.459842.60000 0004 0406 9101Department of Cardiovascular Surgery, Nippon Medical School Musashikosugi Hospital, 1-383 Kosugimachi, Nakahara-Ku, Kawasaki, Kanagawa 211-8533 Japan
| | - Yusuke Motoji
- grid.459842.60000 0004 0406 9101Department of Cardiovascular Surgery, Nippon Medical School Musashikosugi Hospital, 1-383 Kosugimachi, Nakahara-Ku, Kawasaki, Kanagawa 211-8533 Japan
| | - Ryosuke Amitani
- grid.459842.60000 0004 0406 9101Department of Cardiovascular Surgery, Nippon Medical School Musashikosugi Hospital, 1-383 Kosugimachi, Nakahara-Ku, Kawasaki, Kanagawa 211-8533 Japan
| | - Takako Yamaguchi
- grid.459842.60000 0004 0406 9101Department of Nursing, Nippon Medical School Musashikosugi Hospital, 1-383 Kosugimach, Nakahara-ku, Kawasaki, Kanagawa 211-8533 Japan
| | - Yosuke Ishii
- grid.410821.e0000 0001 2173 8328Department of Cardiovascular Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8602 Japan
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12
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Time Trends of Ventricular Reconstruction and Outcomes among Patients with Left Ventricular Thrombus and Aneurysms. J Cardiovasc Dev Dis 2022; 9:jcdd9120464. [PMID: 36547461 PMCID: PMC9784406 DOI: 10.3390/jcdd9120464] [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: 10/29/2022] [Revised: 12/02/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
Background: Clinical guidelines recommend surgical intervention when left ventricular thrombus (LVT) is complicated with left ventricular aneurysm (LVA). Objectives: This study aimed to review the changes in the treatment of LVT combined with LVA over the past 12 years at our center and to compare the efficacy of medical therapy and surgical treatment on patient outcomes. Methods: Between January 2009 and June 2021, 723 patients with LVT combined with LVA were enrolled, of whom 205 received surgical ventricular reconstruction (SVR) therapy and 518 received medical therapy. The following clinical outcomes were gathered via observation: all-cause death, cardiovascular death, and major adverse cardiovascular and cerebrovascular events (MACCEs; defined as the composite of cardiovascular death, ischemic stroke, and acute myocardial infarction). The median follow-up time was 1403 [707, 2402] days. Results: The proportion of SVR dropped yearly in this group of patients, from a peak of 64.5% in 2010 to 7.5% in 2021 (p for trend < 0.001). Meanwhile, the proportion of anticoagulant use increased quickly, from 8.0% in 2016 to 67.9% in 2021 (p for trend < 0.001). The incidence rates of all-cause mortality, cardiovascular death, and MACCEs were 12.9% (n = 93), 10.5% (n = 76), and 14.7% (n = 106), respectively. In the multivariable analysis, there were no significant differences in all-cause death (HR of 0.60, 95% CI of 0.32−1.13, p = 0.11), cardiovascular death (HR of 0.79, 95% CI of 0.41−1.50, p = 0.5), and MACCEs (HR of 0.82, 95% CI of 0.49−1.38, p = 0.5) between the two groups. The competing risk regression performed in the propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) analyses was in line with the unmatched analysis. Conclusions: The rate of SVR dropped significantly among patients with both LVT and LVA, while there was an improvement in oral anticoagulant utilization. SVR with thrombus removal did not improve all-cause mortality and cardiovascular outcomes in patients with LVT and LVA. Ventricular aneurysm with thrombus may not be an indication for surgery.
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13
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De Turck L, Sarens T, Veldeman L, Vonck A. For the love of muscles: a bodybuilder with complicated left ventricular heart failure. Acta Cardiol 2022; 77:774-777. [PMID: 35972452 DOI: 10.1080/00015385.2022.2080919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Anabolic-androgenic steroid misuse is associated with cardiovascular toxicity. We report a unique case of a 46-year-old male bodybuilder with nonischemic systolic heart failure complicated with a large left ventricular thrombus and multiple emboli presumably caused by long-term abuse of anabolic steroids. The patient experienced almost full recovery after cessation of anabolic steroid use, initiation of oral anticoagulation and guideline-directed heart failure medical therapy. This case illustrates the importance of early recognition and appropriate medical management of anabolic-androgenic steroid induced cardiomyopathy.
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Affiliation(s)
- Lidwina De Turck
- Department of Internal Medicine, AZ Sint-Blasius, Dendermonde, Belgium
| | - Tom Sarens
- Department of Cardiology, AZ Sint Blasius, Dendermonde, Belgium
| | - Laurens Veldeman
- Department of Endocrinology, AZ Sint Blasius, Dendermonde, Belgium
| | - An Vonck
- Department of Nephrology, AZ Sint Blasius, Dendermonde, Belgium
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14
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Zhou W, Shi SY, Ye F, Ji Y, Huang J, Yang S, Yang L, Huang S. Risk factors for in-hospital systemic thromboembolism in myocardial infarction patients with left-ventricular thrombus: A multicenter retrospective study. Medicine (Baltimore) 2022; 101:e31053. [PMID: 36253976 PMCID: PMC9575773 DOI: 10.1097/md.0000000000031053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Left-ventricular thrombus (LVT) is a potentially life-threatening disease. However, few studies have explored the risk factors of in-hospital systemic thromboembolism (ST) in LVT patients. In this multicenter retrospective study, we enrolled myocardial infarction patients with LVT from January 2008 to September 2021. Multivariable logistic regression analysis was applied to identify the independent risk factors for ST in LVT patients. A total number of 160 hospitalized LVT patients [median follow-up period 50 months (18.3-82.5 months)] were subjected to analysis. Of them, 54 (33.8%) patients developed acute myocardial infarction, 16 (10%) had ST, and 33 (20.6%) died. Comparable baseline characteristics were established between the ST and non-ST groups, except for the heart failure classification (P = .014). We obtained the following results from our multivariable analysis, based on the use of HFrEF as a reference: HFpEF [odd ratio (OR), 6.2; 95% confidence interval (CI), 1.4-26.3; P = .014] and HFmrEF (OR, 5.0; 95%CI, 1.1-22.2; P = .033). In conclusion, HFpEF, and HFmrEF may be independent risk factors for in-hospital ST development.
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Affiliation(s)
- Wei Zhou
- Department of Cardiology, Yixin People’s Hospital, China
| | - Shun-Yi Shi
- Department of Cardiology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Fei Ye
- Department of Cardiology, Nanjing First Hospital, China
| | - Yuan Ji
- Department of Cardiology, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, China
| | - Jun Huang
- Department of Cardiology, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, China
| | - Song Yang
- Department of Cardiology, Yixin People’s Hospital, China
| | - Lin Yang
- Department of Cardiology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Shenglan Huang
- Department of Cardiology, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, China
- *Correspondence: Shenglan Huang, Department of Cardiology, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, China (e-mail: )
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15
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Levine GN, McEvoy JW, Fang JC, Ibeh C, McCarthy CP, Misra A, Shah ZI, Shenoy C, Spinler SA, Vallurupalli S, Lip GYH. Management of Patients at Risk for and With Left Ventricular Thrombus: A Scientific Statement From the American Heart Association. Circulation 2022; 146:e205-e223. [PMID: 36106537 DOI: 10.1161/cir.0000000000001092] [Citation(s) in RCA: 62] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Despite the many advances in cardiovascular medicine, decisions concerning the diagnosis, prevention, and treatment of left ventricular (LV) thrombus often remain challenging. There are only limited organizational guideline recommendations with regard to LV thrombus. Furthermore, management issues in current practice are increasingly complex, including concerns about adding oral anticoagulant therapy to dual antiplatelet therapy, the availability of direct oral anticoagulants as a potential alternative option to traditional vitamin K antagonists, and the use of diagnostic modalities such as cardiac magnetic resonance imaging, which has greater sensitivity for LV thrombus detection than echocardiography. Therefore, this American Heart Association scientific statement was commissioned with the goals of addressing 8 key clinical management questions related to LV thrombus, including the prevention and treatment after myocardial infarction, prevention and treatment in dilated cardiomyopathy, management of mural (laminated) thrombus, imaging of LV thrombus, direct oral anticoagulants as an alternative to warfarin, treatments other than oral anticoagulants for LV thrombus (eg, dual antiplatelet therapy, fibrinolysis, surgical excision), and the approach to persistent LV thrombus despite anticoagulation therapy. Practical management suggestions in the form of text, tables, and flow diagrams based on careful and critical review of actual study data as formulated by this multidisciplinary writing committee are given.
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16
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Van Le T, Truong T, Phung H, Ngo A, Truong VT, Nguyen DH. Bilateral Renal Artery Thromboembolism During Thrombolytic Therapy for Embolism-Induced Acute Limb Ischemia. JACC Case Rep 2022; 4:1256-1262. [PMID: 36406914 PMCID: PMC9666748 DOI: 10.1016/j.jaccas.2022.07.015] [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: 12/27/2021] [Revised: 07/05/2022] [Accepted: 07/08/2022] [Indexed: 06/16/2023]
Abstract
We report a case of bilateral renal infarction following thrombolytic and anticoagulant therapy for left ventricular embolism-induced lower leg artery ischemia. Imaging demonstrated thrombi from the left ventricle leading to bilateral renal arterial occlusion. Catheter embolectomy and long-term oral anticoagulant therapy were initiated, and the patient recovered with no residual complications. (Level of Difficulty: Intermediate.).
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Affiliation(s)
| | - Thai Truong
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Hung Phung
- Quang Tri General Hospital, Dong Ha, Viet Nam
| | - An Ngo
- University of Pittsburgh Medical Center-McKeesport, McKeesport, Pennsylvania, USA
| | - Vien Thanh Truong
- Department of Internal Medicine, Nazareth Hospital, Philadelphia, Pennsylvania, USA
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17
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Li C, Lau W, Qian N, Song L, Jin C, Zhou D, Yu Y, Pan X, Zhou Q. Clinical characteristics and prognosis of patients with left ventricular thrombus in East China. Front Cardiovasc Med 2022; 9:944687. [PMID: 36158827 PMCID: PMC9492992 DOI: 10.3389/fcvm.2022.944687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 08/03/2022] [Indexed: 11/21/2022] Open
Abstract
Background Left ventricular thrombus (LVT) is a serious complication in patients with left ventricular dysfunction. However, there is still a paucity of data on treatments and prognosis of patients with LVT. This study aims to evaluate the clinical characteristics of patients with LVT and to determine the impact of LVT on the incidence of major adverse cardiovascular events (MACEs) and all-cause mortality. Methods From January 2010 to January 2020, 237 patients diagnosed with LVT at The Second Affiliated Hospital Zhejiang University School of Medicine in East China were retrospectively included. Clinical characteristics, treatments, MACEs, and bleeding events [thrombolysis in myocardial infarction (TIMI) I and II] were collected. MACE is determined as the composite of all-cause mortality, ischemic stroke, acute myocardial infarction (MI), and acute peripheral artery emboli. Results The all-cause mortality rate was 28.3% (89.6% due to cardiovascular death), ischemic stroke 8.4%, MI 3%, peripheral artery emboli 1.7%, and bleeding events (TIMI I and II) 7.6% were found during a median follow-up of 736 days. Total LVT regression occurred in 152 patients (64.1%). Atrial fibrillation [hazard ratio (HR), 3.049; 95% confidence interval (95% CI) 1.264–7.355; p = 0.013], moderate and severe renal function injuries (HR, 2.097; 95% CI, 1.027–4.281; p = 0.042), and left ventricular ejection fraction (LVEF) ≤ 50% (HR, 2.243; 95% CI 1.090–4.615; p = 0.028) were independent risk factors for MACE, whereas the use of β-blocker (HR, 0.397; 95% CI 0.210–0.753; p = 0.005) was its protective factor. Age (HR, 1.021; 95% CI 1.002–1.040; p = 0.031), previous caronary artery bypass grafting (CABG; HR, 4.634; 95% CI 2.042–10.517; p < 0.001), LVEF ≤ 50% (HR, 3.714; 95% CI 1.664–8.290; p = 0.001), and large thrombus area (HR, 1.071; 95% CI 1.019–1.126; p = 0.007) were independent risk factors for increasing all-cause mortality, whereas the use of β-blocker (HR, 0.410; 95% CI 0.237–0.708; p = 0.001) was protective factor. Conclusion This study showed that atrial fibrillation, moderate and severe renal dysfunction, and LVEF ≤ 50% were independent risk factors for MACE; age, previous CABG, LVEF ≤ 50%, and large thrombus area were independent risk factors for all-cause mortality. It was found that the use of β-blockers could improve the prognosis of patient with LVT for the first time. It is recommended that clinicians could be more active in applying patient with LVT with anticoagulants.
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Affiliation(s)
- Cheng Li
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Wenjie Lau
- Department of Cardiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ningjing Qian
- Department of Cardiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Liuguang Song
- Department of Cardiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Chunna Jin
- Department of Cardiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Dao Zhou
- Department of Cardiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yi Yu
- Department of Cardiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaohong Pan
- Department of Cardiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- *Correspondence: Xiaohong Pan,
| | - Quan Zhou
- Department of Pharmacy, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Quan Zhou,
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18
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Weberling LD, Steen H, Frey N, André F. Large Mobile Left Ventricular Thrombi Formation in a 32-Year-Old Despite Direct Oral Anticoagulation With Dabigatran. JACC Case Rep 2022; 4:1015-1019. [PMID: 36062055 PMCID: PMC9434649 DOI: 10.1016/j.jaccas.2022.05.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/19/2022] [Accepted: 05/26/2022] [Indexed: 11/08/2022]
Abstract
Direct oral anticoagulant agents (DOACs) are widely used in the treatment of arterial and venous thrombi. We report the case of a 32-year-old patient who was receiving permanent DOAC therapy. Despite adequate use, 2 large left ventricular thrombi developed. Surgical thrombectomy was performed. The patient recovered well and received anticoagulation with phenprocoumon thereafter. (Level of Difficulty:Beginner.)
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19
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Kimihira L, Tanaka T, Mizumoto A, Ihara M. Dedicated transthoracic echocardiography to identify apical thrombus causing recurrent cerebral embolism: a case report. Acta Neurol Belg 2022:10.1007/s13760-022-01995-0. [PMID: 35650418 DOI: 10.1007/s13760-022-01995-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 05/25/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Luna Kimihira
- Department of Neurology, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Tomotaka Tanaka
- Department of Neurology, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan.
| | - Ayaka Mizumoto
- Department of Clinical Laboratory, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
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20
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Sakakibara T, Suwa K, Ushio T, Wakayama T, Alley M, Saotome M, Satoh H, Maekawa Y. Intra-Left Ventricular Hemodynamics Assessed with 4D Flow Magnetic Resonance Imaging in Patients with Left Ventricular Thrombus. Int Heart J 2021; 62:1287-1296. [PMID: 34853222 DOI: 10.1536/ihj.20-792] [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: 11/18/2022]
Abstract
Left ventricular thrombus (LVT) has been identified to be crucial in patients with reduced ejection fraction (EF). Three-dimensional cine phase-contrast magnetic resonance imaging (4D flow MRI) can visualize the intra-LV vortex during diastole and quantify the maximum flow velocity (Vmax) at the apex. In this study, we investigated whether the change in the intra-LV vortex was associated with the presence of LVT in patients with cardiac disease.In total, 36 patients (63.5 ± 11.9 years, 28 men, 12/24 with/without LVT) with diffuse LV dysfunction underwent 4D flow MRI. The relative vortex area using streamline images and Vmax of blood flow toward the apex at the apical left ventricle were evaluated. The correlation between the relative vortex area and Vmax was assessed using Pearson's correlation coefficient. The ability to detect LVT was evaluated using the area under the curve (AUC) of the receiver operating characteristic.The relative vortex area was found to be smaller (27 ± 10% versus 45 ± 11%, P = 0.000026), whereas Vmax at the apical left ventricle was lower (19.1 ± 4.4 cm/second versus 27.4 ± 8.9 cm/second, P = 0.0006) in patients with LVT. Vmax at the apical left ventricle demonstrated significant correlations with the relative vortex area (r = 0.43, P = 0.01) and relative transverse length of the vortex (r = 0.45, P = 0.007). The AUC was 0.91 for the relative vortex area, whereas it was 0.80 for Vmax in the apical left ventricle.A smaller LV vortex and lower flow velocity at the LV apex were associated with LVT in patients with reduced EF.
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Affiliation(s)
- Tomoaki Sakakibara
- Division of Cardiology, Internal Medicine 3, Hamamatsu University School of Medicine
| | - Kenichiro Suwa
- Division of Cardiology, Internal Medicine 3, Hamamatsu University School of Medicine
| | - Takasuke Ushio
- Department of Radiology, Hamamatsu University School of Medicine
| | | | - Marcus Alley
- Division of Radiology, Stanford University School of Medicine, Stanford
| | - Masao Saotome
- Division of Cardiology, Internal Medicine 3, Hamamatsu University School of Medicine
| | - Hiroshi Satoh
- Department of Cardiology, Fujinomiya City General Hospital
| | - Yuichiro Maekawa
- Division of Cardiology, Internal Medicine 3, Hamamatsu University School of Medicine
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21
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Goyal A, Srinivasaiah B, Kumar MK, Paul A. Large left ventricular thrombus with malignant left MCA infarct for emergency decompressive craniectomy. J Anaesthesiol Clin Pharmacol 2021; 37:489-490. [PMID: 34759571 PMCID: PMC8562450 DOI: 10.4103/joacp.joacp_267_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 01/06/2020] [Accepted: 02/24/2020] [Indexed: 12/02/2022] Open
Affiliation(s)
- Amit Goyal
- Department of Neuroanaesthesia, NIMHANS, Bangalore, Karnataka, India
| | | | - Mathangi K Kumar
- Department of Neuroanaesthesia, NIMHANS, Bangalore, Karnataka, India
| | - Anto Paul
- Department of Neuroanaesthesia, NIMHANS, Bangalore, Karnataka, India
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22
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Janula M, Navarro A, Bonello J, Schembri K, Borg A. Trans-aortic left ventricular thrombo-embolectomy following COVID-19 infection. J Surg Case Rep 2021; 2021:rjab426. [PMID: 34594494 PMCID: PMC8478470 DOI: 10.1093/jscr/rjab426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 09/04/2021] [Indexed: 11/13/2022] Open
Abstract
Left ventricular thrombosis is a known complication of myocardial infarction. COVID 19 has been shown to produce a procoagulant state resulting in venous and less commonly arterial thrombosis. Here, we describe a patient who presented with a non-ST elevation myocardial infarction (NSTEMI), in the context of a COVID 19 infection. This NSTEMI resulted in the formation of a large pedunculated apical thrombus, which was initially managed conservatively, however ultimately required surgical thromboembolectomy. Access to the left ventricle was gained via the transaortic route in order to avoid ventriculotomy in a patient with a reduced LV systolic function. Post-operative imaging confirmed complete resection of thrombus.
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Affiliation(s)
- Michael Janula
- Department of Cardiothoracic Surgery, Mater Dei Hospital, Msida, Malta
| | - Andre Navarro
- Department of Cardiothoracic Surgery, Mater Dei Hospital, Msida, Malta
| | - John Bonello
- Department of Cardiology, Mater Dei Hospital, Msida, Malta
| | - Kevin Schembri
- Department of Cardiothoracic Surgery, Mater Dei Hospital, Msida, Malta
| | - Alex Borg
- Department of Cardiology, Mater Dei Hospital, Msida, Malta
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23
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Patel M, Wei X, Weigel K, Gertz ZM, Kron J, Robinson AA, Trankle CR. Diagnosis and Treatment of Intracardiac Thrombus. J Cardiovasc Pharmacol 2021; 78:361-371. [PMID: 34074905 DOI: 10.1097/fjc.0000000000001064] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/01/2021] [Indexed: 11/27/2022]
Abstract
ABSTRACT Intracardiac thrombi can occur in a variety of locations and are frequently encountered in clinical practice. Yet evidence-based guidance for clinicians managing patients with intracardiac thrombi is often limited. This review summarizes what is known regarding the prevalence of intracardiac thrombus, diagnostic strategies, clinical relevance, and treatment options, focusing on four specific types of thrombus for which recent research has shifted clinical understanding and treatment decisions: (1) left atrial appendage thrombus, (2) cardiac implantable electronic device lead thrombus, (3) bioprosthetic aortic valve thrombus, and (4) left ventricular thrombus. Additional studies, ideally prospective, randomized, and head-to-head in design, are needed to better inform best practices in patients with intracardiac thrombi.
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Affiliation(s)
- Murti Patel
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA
| | - Xin Wei
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA
| | - Kylie Weigel
- School of Pharmacy, Virginia Commonwealth University, Richmond, VA; and
| | - Zachary M Gertz
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA
| | - Jordana Kron
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA
| | | | - Cory R Trankle
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA
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Eranki A, Villanueva C, Collins N, Seah P. Video assisted, transaortic removal of left ventricular thrombus during concurrent cardiac surgery: a case report. J Cardiothorac Surg 2021; 16:242. [PMID: 34446037 PMCID: PMC8390245 DOI: 10.1186/s13019-021-01626-4] [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: 06/30/2021] [Accepted: 07/29/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction Left ventricular (LV) thrombus is a complication of acute myocardial infarction and is associated with systemic thromboembolism. We describe a trans-aortic endoscopic approach to the removal of an LV thrombus in a patient undergoing concurrent coronary artery bypass grafting and aortic valve replacement. Case presentation A 47 year old male presented following an embolic middle cerebral artery stroke and underwent transthoracic echocardiography demonstrating a mobile LV thrombus. Additional investigation revealed a moderately stenosed bicispid aortic valve, two vessel coronary artery disease and ischemic cardiomyopathy. The patient underwent early surgery to reduce the risk of further embolic episodes. A trans-aortic approach was utilized with videoscopy and single shafted instrumentation to aide in removal of the thrombus. The patient then underwent aortic valve replacement and coronary artery bypass grafting. Conclusion We report an alternative technique for the removal of a left ventricular thrombus in a patient undergoing concurrent coronary and aortic valve surgery. The transaortic video-assisted approach provided excellent visualisation of the apex and near complete removal of the thrombus without damaging the surrounding trabeculae. The main benefit of this technique is sparing of LV tissue, thereby preserving left ventricular function.
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Affiliation(s)
| | | | | | - Peng Seah
- John Hunter Hospital, Newcastle, Australia
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25
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Cohen A, Donal E, Delgado V, Pepi M, Tsang T, Gerber B, Soulat-Dufour L, Habib G, Lancellotti P, Evangelista A, Cujec B, Fine N, Andrade MJ, Sprynger M, Dweck M, Edvardsen T, Popescu BA. EACVI recommendations on cardiovascular imaging for the detection of embolic sources: endorsed by the Canadian Society of Echocardiography. Eur Heart J Cardiovasc Imaging 2021; 22:e24-e57. [PMID: 33709114 DOI: 10.1093/ehjci/jeab008] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 01/07/2021] [Indexed: 12/28/2022] Open
Abstract
Cardioaortic embolism to the brain accounts for approximately 15-30% of ischaemic strokes and is often referred to as 'cardioembolic stroke'. One-quarter of patients have more than one cardiac source of embolism and 15% have significant cerebrovascular atherosclerosis. After a careful work-up, up to 30% of ischaemic strokes remain 'cryptogenic', recently redefined as 'embolic strokes of undetermined source'. The diagnosis of cardioembolic stroke remains difficult because a potential cardiac source of embolism does not establish the stroke mechanism. The role of cardiac imaging-transthoracic echocardiography (TTE), transoesophageal echocardiography (TOE), cardiac computed tomography (CT), and magnetic resonance imaging (MRI)-in the diagnosis of potential cardiac sources of embolism, and for therapeutic guidance, is reviewed in these recommendations. Contrast TTE/TOE is highly accurate for detecting left atrial appendage thrombosis in patients with atrial fibrillation, valvular and prosthesis vegetations and thrombosis, aortic arch atheroma, patent foramen ovale, atrial septal defect, and intracardiac tumours. Both CT and MRI are highly accurate for detecting cavity thrombosis, intracardiac tumours, and valvular prosthesis thrombosis. Thus, CT and cardiac magnetic resonance should be considered in addition to TTE and TOE in the detection of a cardiac source of embolism. We propose a diagnostic algorithm where vascular imaging and contrast TTE/TOE are considered the first-line tool in the search for a cardiac source of embolism. CT and MRI are considered as alternative and complementary tools, and their indications are described on a case-by-case approach.
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Affiliation(s)
- Ariel Cohen
- Assistance Publique-Hôpitaux de Paris, Saint-Antoine and Tenon Hospitals, Department of Cardiology, and Sorbonne University, Paris, France.,INSERM unit UMRS-ICAN 1166; Sorbonne-Université, Paris, France
| | - Erwan Donal
- University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Mauro Pepi
- Centro Cardiologico Monzino, IRCCS, Via Parea 4, 20141, Milan, Italy
| | - Teresa Tsang
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bernhard Gerber
- Service de Cardiologie, Département Cardiovasculaire, Cliniques Universitaires St. Luc, Division CARD, Institut de Recherche Expérimental et Clinique (IREC), UCLouvainAv Hippocrate 10/2803, B-1200 Brussels, Belgium
| | - Laurie Soulat-Dufour
- Assistance Publique-Hôpitaux de Paris, Saint-Antoine and Tenon Hospitals, Department of Cardiology, and Sorbonne University, Paris, France.,INSERM unit UMRS-ICAN 1166; Sorbonne-Université, Paris, France
| | - Gilbert Habib
- Aix Marseille Univ, IRD, MEPHI, IHU-Méditerranée Infection, APHM, La Timone Hospital, Cardiology Department, Marseille, France
| | - Patrizio Lancellotti
- University of Liège Hospital, GIGA Cardiovascular Sciences, Department of Cardiology, CHU SartTilman, Liège, Belgium.,Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola, and Anthea Hospital, Bari, Italy
| | - Arturo Evangelista
- Servei de Cardiologia. Hospital Universitari Vall d'Hebron-VHIR. CIBER-CV. Pº Vall d'Hebron 119. 08035. Barcelona. Spain
| | - Bibiana Cujec
- Division of Cardiology, University of Alberta, 2C2.50 Walter Mackenzie Health Sciences Center, 8440 112 St NW, Edmonton, Alberta, Canada T6G 2B7
| | - Nowell Fine
- University of Calgary, Libin Cardiovascular Institute, South Health Campus, 4448 Front Street Southeast, Calgary, Alberta T3M 1M4, Canada
| | - Maria Joao Andrade
- Maria Joao Andrade Cardiology Department, Hospital de Santa Cruz-Centro Hospitalar Lisboa Ocidental, Av. Prof. Dr. Reinaldo dos Santos 2790-134 Carnaxide, Portugal
| | - Muriel Sprynger
- Department of Cardiology-Angiology, University Hospital Liège, Liège, Belgium
| | - Marc Dweck
- British Heart Foundation, Centre for Cardiovascular Science, Edinburgh and Edinburgh Imaging Facility QMRI, University of Edinburgh, United Kingdom
| | - Thor Edvardsen
- Faculty of medicine, Oslo University, Oslo, Norway and Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Bogdan A Popescu
- Cardiology Department, University of Medicine and Pharmacy 'Carol Davila', Emergency Institute for Cardiovascular Diseases 'Prof. Dr. C. C. Iliescu', Sos. Fundeni 258, sector 2, 022328 Bucharest, Romania
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26
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Sonaglioni A, Albini A, Nicolosi GL, Rigamonti E, Noonan DM, Lombardo M. Case Report: An Unusual Case of Biventricular Thrombosis in a COVID-19 Patient With Ischemic Dilated Cardiomyopathy: Assessment of Mass Mobility and Embolic Risk by Tissue Doppler Imaging. Front Cardiovasc Med 2021; 8:694542. [PMID: 34395561 PMCID: PMC8358798 DOI: 10.3389/fcvm.2021.694542] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/21/2021] [Indexed: 12/24/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein binds to angiotensin-converting enzyme 2 (ACE2) receptor on vascular cells. As a consequence, patients with COVID-19 have an increased incidence of thromboembolic complications of the SARS-CoV-2 infection and subsequent endothelial cell damage with consequence of development of systemic vasculitis and diffuse intravascular coagulation. The present case describes a COVID-19 female patient with ischemic dilated cardiomyopathy, who presented with congestive heart failure and echocardiographic evidence of biventricular apical thrombi. The peak antegrade longitudinal velocity (Va) of each thrombotic mass was measured by pulsed wave tissue Doppler imaging (PW-TDI). Both left ventricular and right ventricular apical thrombi were found with a TDI-derived mass peak Va < 10 cm/s. There was no clinical evidence of neither systemic nor pulmonary embolization, probably due to the hypomobility of both left and right ventricular masses.
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Affiliation(s)
- Andrea Sonaglioni
- Department of Cardiology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Multi Medica, Milan, Italy
| | - Adriana Albini
- Scientific and Technological Pole, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Multi Medica, Milan, Italy
| | | | - Elisabetta Rigamonti
- Department of Cardiology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Multi Medica, Milan, Italy
| | - Douglas M Noonan
- Scientific and Technological Pole, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Multi Medica, Milan, Italy.,Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Michele Lombardo
- Department of Cardiology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Multi Medica, Milan, Italy
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27
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Kitano T, Nabeshima Y, Kataoka M, Takeuchi M. Therapeutic efficacy of direct oral anticoagulants and vitamin K antagonists for left ventricular thrombus: Systematic review and meta-analysis. PLoS One 2021; 16:e0255280. [PMID: 34310654 PMCID: PMC8312978 DOI: 10.1371/journal.pone.0255280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 07/14/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Although several meta-analyses have compared efficacies of vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs) for treatment of left ventricular thrombus (LVT), those meta-analyses included no single-arm studies. METHODS AND RESULTS PubMed, Scopus, and the Cochrane Library databases were searched for articles investigating thrombus resolution, stroke, any thromboembolism, major bleeding, any bleeding, or all-cause death in LVT treated with VKAs or DOACs, and single-class meta-analyses were also included (PROSPERO database, CRD42021230849). Event rates were pooled using a random effects model. Meta-regression analysis was performed to explore factors that may influence outcomes. 2,612 patients from 23 articles were included (VKAs: 2,004, DOACs: 608). There were no significant differences between VKAs and DOACs in the frequency of thrombus resolution (VKAs: 0.75 [95% confidence interval; 0.67 to 0.81], DOACs: 0.75 [0.67 to 0.82]), stroke (VKAs: 0.06 [0.04 to 0.10], DOACs: 0.02 [0.01 to 0.01]), any thromboembolism (VKAs: 0.08 [0.05 to 0.13], DOACs: 0.03 [0.01 to 0.10]), major bleeding (VKAs: 0.06 [0.04 to 0.09], DOACs: 0.03 [0.01 to 0.06]), any bleeding (VKAs: 0.08 [0.05 to 0.12], DOACs: 0.08 [0.06 to 0.10]), and all-cause death (VKAs: 0.07 [0.04 to 0.13], DOACs: 0.09 [0.05 to 0.16]). Meta-regression analysis revealed that increased duration of follow-up was associated with lower-rates of stroke (estimate: -0.040, p = 0.0495) with VKAs, but not with DOACs. There was significant publication bias for thrombus resolution, stroke, any thromboembolism, any bleeding, and all-cause death. CONCLUSIONS Efficacy and adverse outcomes of therapy with DOACs and VKAs do not differ. Randomized controlled trials are needed to determine the optimal anticoagulant strategy.
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Affiliation(s)
- Tetsuji Kitano
- Department of Cardiology and Nephrology, Wakamatsu Hospital of the University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yosuke Nabeshima
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
| | - Masaharu Kataoka
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
| | - Masaaki Takeuchi
- Department of Laboratory and Transfusion Medicine, University of Occupational and Environmental Health Hospital, Kitakyushu, Japan
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28
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Alcalai R, Butnaru A, Moravsky G, Yagel O, Rashad R, Ibrahimli M, Planer D, Amir O, Elbaz-Greener G, Leibowitz D. Apixaban versus Warfarin in Patients with Left Ventricular Thrombus, A Prospective Multicenter Randomized Clinical Trial. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2021; 8:660-667. [PMID: 34279598 DOI: 10.1093/ehjcvp/pvab057] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 06/06/2021] [Accepted: 07/14/2021] [Indexed: 12/23/2022]
Abstract
AIMS Current guidelines recommend anticoagulation with a vitamin K antagonist to treat left ventricular (LV) thrombus post myocardial infarction (MI). Data on the use of direct oral anticoagulants (DOACS) in this setting is limited. The aim of the study was to assess the efficacy of apixaban versus warfarin in treating LV thrombus after MI. METHODS AND RESULTS A prospective, randomized, multi-center open label clinical trial including patients with LV thrombus detected by 2D-transthoracic-echocardiography 1-14 days after acute MI. Thirty-five patients were enrolled in 3 medical centers, 17 patients were randomized to warfarin and 18 patients to apixaban. The primary outcome was the presence and size of LV thrombus 3 months after initiation of anticoagulation. Secondary outcomes were major bleeding, stroke or systemic embolism, re-hospitalization, and all-cause mortality. Mean LV thrombus size at enrollment was 18.5 × 12.3 mm in the warfarin group and 19.9 × 12.4 mm in the apixaban group (P = NS). Thirty-two patients completed 3 months follow-up. In the warfarin group two patients withdrew and in the apixaban group one patient died. Thrombus completely resolved in 14 of 15 patients in the warfarin group and in 16 of 17 in the apixaban group ((P = NS, P = 0.026 for non-inferiority). Two patients had major bleeding in the warfarin group while no major bleeding events were recorded in the apixaban group. There was one stroke in the warfarin group and one death in the apixaban group. CONCLUSION Our results suggest that apixaban is non-inferior to warfarin for treatment of patients with LV thrombus after acute MI with a 20% non-inferiority margin.
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Affiliation(s)
- Ronny Alcalai
- Department of Cardiology, Hadassah Medical Center and faculty of medicine, Hebrew University of Jerusalem, Israel
| | - Adi Butnaru
- Heart Institute, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Gil Moravsky
- Cardiology department, Shamir Medical Center, Tzrifin, Israel
| | - Oren Yagel
- Department of Cardiology, Hadassah Medical Center and faculty of medicine, Hebrew University of Jerusalem, Israel
| | - Razek Rashad
- Department of Cardiology, Hadassah Medical Center and faculty of medicine, Hebrew University of Jerusalem, Israel
| | - Mahsati Ibrahimli
- Department of Cardiology, Hadassah Medical Center and faculty of medicine, Hebrew University of Jerusalem, Israel
| | - David Planer
- Department of Cardiology, Hadassah Medical Center and faculty of medicine, Hebrew University of Jerusalem, Israel
| | - Offer Amir
- Department of Cardiology, Hadassah Medical Center and faculty of medicine, Hebrew University of Jerusalem, Israel
| | - Gabby Elbaz-Greener
- Department of Cardiology, Hadassah Medical Center and faculty of medicine, Hebrew University of Jerusalem, Israel
| | - David Leibowitz
- Department of Cardiology, Hadassah Medical Center and faculty of medicine, Hebrew University of Jerusalem, Israel
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29
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Kleindorfer DO, Towfighi A, Chaturvedi S, Cockroft KM, Gutierrez J, Lombardi-Hill D, Kamel H, Kernan WN, Kittner SJ, Leira EC, Lennon O, Meschia JF, Nguyen TN, Pollak PM, Santangeli P, Sharrief AZ, Smith SC, Turan TN, Williams LS. 2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline From the American Heart Association/American Stroke Association. Stroke 2021; 52:e364-e467. [PMID: 34024117 DOI: 10.1161/str.0000000000000375] [Citation(s) in RCA: 1047] [Impact Index Per Article: 349.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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30
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Dogan G, Mariani S, Hanke JS, Deniz E, Merzah A, Li T, Haverich A, Schmitto JD. Left ventricular assist device implantation in patients with left ventricular thrombus. Artif Organs 2021; 45:1006-1013. [PMID: 33872409 DOI: 10.1111/aor.13963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/23/2021] [Accepted: 03/31/2021] [Indexed: 12/29/2022]
Abstract
An intra-cavitary left ventricular (LV) thrombus is a relative contraindication to LV assist device (LVAD) implantation based on increased thromboembolic risks. Herein, we present our experience with LVAD patients with or without preoperative diagnosis of LV-thrombus. We retrospectively investigated 563 patients who received LVAD implantation between 2004 and 2018. Diagnosis of LV-thrombus was verified with computed tomography scan, magnetic resonance imaging, echocardiography, or intraoperative LV inspection. The primary endpoint was 30-day survival free of stroke and pump thrombosis. Overall, 72 patients (12.8%) had a diagnosis of LV-thrombus. They were younger (51 years; IQR:41-59), affected by severely reduced ejection fraction (15%; IQR:10-20), more often presenting with dilated cardiomyopathy (61.8%) and INTERMACS profile 1 (33.3%). Preoperative atrial fibrillation was frequent in patients without LV-thrombus (38.9%). Conventional sternotomy was the preferred approach in LV-thrombus patients (77.8%), based on more HMII implantations in these patients (41.7%). Survival free of strokes and pump thrombosis at 30 days was comparable (P = .5751) between patients with (83.3%) or without LV-thrombus (80.9%). LVAD implantation in patients with preoperative LV-thrombus is safe and feasible. When managed through correct diagnostic and intraoperative strategies including accurate inspection of the LV cavity, these patients show similar 30-day outcomes compared to patients without LV-thrombus.
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Affiliation(s)
- Günes Dogan
- Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Silvia Mariani
- Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jasmin S Hanke
- Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Ezin Deniz
- Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Ali Merzah
- Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Tong Li
- Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jan D Schmitto
- Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
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31
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An Z, Gao Z, Wang L, Hou C, Zhang L, Gong S, Rao R, Li C, Qin Z. Prognostic Significance of B-Type Natriuretic Peptide in Patients With Left Ventricular Thrombus. Front Cardiovasc Med 2021; 8:667908. [PMID: 33996952 PMCID: PMC8116499 DOI: 10.3389/fcvm.2021.667908] [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: 02/15/2021] [Accepted: 04/06/2021] [Indexed: 11/30/2022] Open
Abstract
Background and Aims: There is sparse information on the prognostic value of B-type natriuretic peptide (BNP) for the outcomes in patients with left ventricular thrombus (LVT). Methods: Patients diagnosed with LVT by transthoracic echocardiography between November 2009 to July 2020 at our institution were included. The endpoints were all-cause mortality and systemic embolism. Results: Ninety-two subjects were finally included in the study. The mean age of the cohort was 56.73 ± 14.12, and 80.4% of the patients were male. The median BNP (1st quartile−3rd quartile) was 437.5 (112.74–1317.5). The total all-cause mortality rate was 30.44% (28/92), and the 1-year, 2-year, and 3-year cumulative survival rates were 85.4, 75.5, and 66.5%, respectively. Systemic embolism was identified in 10 subjects. COX multivariate analysis showed that Log BNP (HR, 4.16; 95%CI, 1.81–9.56; P = 0.001) and BMI (HR, 0.86; 95%CI, 0.73–0.99; P = 0.048) were significantly associated with all-cause mortality. In addition, patients with BNP levels in the upper median (≥ 437.5 pg/ml) had significantly higher all-cause mortality rate compared to those with lower median BNP (<437.5 pg/ml; P = 0.004). The area under the receiver operating characteristic curve for BNP and all-cause mortality was 0.71. In the linear trend test, BNP quartiles were significantly related to all-cause mortality in all models, and the P-values for trend in models 1, 2, and 3 were 0.005, 0.006, and 0.048, respectively. Conclusion: BNP level is a prognostic factor for all-cause mortality in LVT patients, and elevated BNP is indicative of a higher risk of LVT.
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Affiliation(s)
- Zhixia An
- Department of Cardiology, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China.,Institute of Cardiovascular Diseases of PLA, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Zhichun Gao
- Department of Cardiology, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China.,Institute of Cardiovascular Diseases of PLA, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Luyu Wang
- Department of Cardiology, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China.,Institute of Cardiovascular Diseases of PLA, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Changchun Hou
- Department of Cardiology, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China.,Institute of Cardiovascular Diseases of PLA, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Liying Zhang
- Department of Cardiology, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China.,Department of Cardiology, Shapingba District People's Hospital, Chongqing, China
| | - Siming Gong
- Department of Ultrasound, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Rongsheng Rao
- Department of Ultrasound, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Chun Li
- Department of Ultrasound, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Zhexue Qin
- Department of Cardiology, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China.,Institute of Cardiovascular Diseases of PLA, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
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Hoshino S, Kido K, Maeda K, Ichiba T, Takatori M. Delayed Obstructive Hydrocephalus After Cardiac Surgery With Cardiopulmonary Bypass in a Patient With Cerebellar Infarction: A Case Report. A A Pract 2021; 15:e01439. [PMID: 33783405 DOI: 10.1213/xaa.0000000000001439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Obstructive hydrocephalus caused by brainstem compression is a life-threatening complication and usually occurs within 6 days, with peak on day 3 after onset of cerebellar infarction. We present a case of obstructive hydrocephalus that developed on day 8 in a patient with cerebellar infarction. A 39-year-old man with cerebellar infarction caused by myocardial infarction-related intraventricular thrombus underwent left ventricular thrombectomy under cardiopulmonary bypass. He was lucid postoperatively, but his consciousness was diminished on day 8 because of obstructive hydrocephalus. Cerebral edema due to cardiopulmonary bypass may contribute to delayed onset of obstructive hydrocephalus, especially in patients with large-sized cerebellar infarction.
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Affiliation(s)
- Shun Hoshino
- From the Departments of Anesthesiology and Intensive Care Medicine and
| | - Koji Kido
- From the Departments of Anesthesiology and Intensive Care Medicine and
| | - Keisuke Maeda
- Emergency Medicine, Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Toshihisa Ichiba
- Emergency Medicine, Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Makoto Takatori
- From the Departments of Anesthesiology and Intensive Care Medicine and
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Lemaître AI, Picard F, Maurin V, Faure M, Dos Santos P, Girerd N. Clinical profile and midterm prognosis of left ventricular thrombus in heart failure. ESC Heart Fail 2021; 8:1333-1341. [PMID: 33629818 PMCID: PMC8006720 DOI: 10.1002/ehf2.13211] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 12/07/2020] [Accepted: 01/02/2021] [Indexed: 12/30/2022] Open
Abstract
Aims We documented the midterm prognosis of left ventricular thrombus (LVT) in heart failure (HF) patients with dilated cardiomyopathy (DCM) and ischaemic cardiomyopathy (ICM). We aimed to characterize patients with LVT in the context of HF with reduced (≤40%) left ventricular ejection fraction and evaluate their risk for death and/or embolic events, overall, and specifically in patients with ischaemic or non‐ischaemic aetiology. We also intended to identify risk factors for LVT in patients with DCM. Methods and results We included all HF patients (N = 105, age 56 ± 13) admitted from 2005 to 2018 in our institution for LVT without significant valve disease/prosthesis, heart transplant/left ventricular assist device, congenital heart disease, or acute myocardial infarction. Our primary endpoint was the 1 year risk of the composite of all‐cause mortality (ACM) and symptomatic embolic events. Mean left ventricular ejection fraction was 23 ± 9%, and median BNP was 1795 pg/mL. Most (97%) patients were treated with vitamin K anticoagulants, and 64% had ICM. Symptomatic embolic events and/or ACM occurred in 20% of the population [embolic events (all within 30 days of LVT diagnosis) 15% and ACM 6%] and was similarly frequent in DCM or ICM (P > 0.05). Suspected/transient embolic events were more frequent in DCM (overall 13%; 29% in DCM vs. 5% in ICM, P < 0.01). Major bleeding occurred in 5% of patients. Left ventricular reverse remodelling occurred in 65% of patients, more frequently in DCM (86% in DCM vs. 65% in ICM, P = 0.02). In a case–control analysis matching DCM patients, BNP level was the only factor significantly associated with LVT (2447 pg/mL in LVT vs. 347 pg/mL, P < 0.001). Conclusions Patients with LVT have markedly high natriuretic peptides and experience a 20% 1 year risk for embolic events and/or death following diagnosis despite anticoagulant treatment. Most patients have favourable remodelling/recovery. As all symptomatic embolic events occurred within 30 days of LVT diagnosis, a very careful initial management is warranted.
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Affiliation(s)
| | | | | | - Maxime Faure
- Bordeaux University Hospital (CHU), Bordeaux, France
| | - Pierre Dos Santos
- Bordeaux University Hospital (CHU), Bordeaux, France.,Centre de Recherche Cardio-Thoracique de Bordeaux, Université de Bordeaux, Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modelling Institute, Foundation Bordeaux Université, Bordeaux, France
| | - Nicolas Girerd
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques Plurithématique 1433, Inserm U1116, CHRU Nancy, and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
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34
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Additional information on our report: Trabeculectomy for left ventricular noncompaction. Ann Thorac Surg 2021; 112:1724-1725. [PMID: 33581163 DOI: 10.1016/j.athoracsur.2021.01.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 01/20/2021] [Indexed: 11/22/2022]
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35
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Shalabi AG, Henaidi MH, Bakhsh RS, Sulaiman AA, Alhawsawi DA, Hussein WM. Use of point-of-care ultrasound to diagnose an alternate cause of flank pain in a patient with presumed renal colic. J Am Coll Emerg Physicians Open 2021; 2:e12342. [PMID: 33532750 PMCID: PMC7831614 DOI: 10.1002/emp2.12342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 12/06/2020] [Accepted: 12/08/2020] [Indexed: 02/01/2023] Open
Abstract
This is a case of a 34-year-old male patient who presented to the emergency department (ED) with severe left flank pain. Due to the patient's cardiac history, elevated troponin, lactic acidosis, and lack of renal calculi on a noncontrast CT, focused cardiac ultrasound was performed, which showed left ventricle thrombus. The patient was later found to have bi-interventricular thrombi causing both pulmonary embolism and renal infarction. This is an uncommon diagnosis in the ED, where point-of-care ultrasound helped in diagnosing and guiding the management and disposition of this case.
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Affiliation(s)
| | | | | | | | | | - Waleed M. Hussein
- Emergency Medicine DepartmentKing Abdullah Medical CityMakkahSaudi Arabia
- Emergency Medicine DepartmentKing Faisal Medical city for Southern RegionsAbhaSaudi Arabia
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36
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Powers WJ. Clinical utility of echocardiography in secondary ischemic stroke prevention. HANDBOOK OF CLINICAL NEUROLOGY 2021; 177:359-375. [PMID: 33632453 DOI: 10.1016/b978-0-12-819814-8.00022-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Echocardiography employs ultrasound to evaluate cardiac function, structure and pathology. The clinical value in secondary ischemic stroke prevention depends on identification of associated conditions for which a change in treatment from antiplatelet agents and risk factor intervention leads to improved outcomes. Such therapeutically relevant findings include primarily intracardiac thrombus, valvular heart disease and, in highly selected patients, patent foramen ovale (PFO). Echocardiography in unselected patients with ischemic stroke has a very low yield of therapeutically relevant findings and is not cost-effective. With the exception of PFO, findings on echocardiography that are therapeutically relevant for secondary stroke prevention are almost always associated with history, signs or symptoms of cardiac or systemic disease. Choice of specific echocardiographic modalities should be based on the specific pathology or pathologies that are under consideration for the individual clinical situation. Transthoracic echocardiography (TTE) with agitated saline has comparable accuracy to transesophageal echocardiography (TEE) for PFO detection. For other therapeutically relevant pathologies, with the possible exception of left ventricular thrombus (LVT), TEE is more sensitive than TTE. Professional societies recommend TTE as the initial test but these recommendations do not take cost into account. In contrast, cost-effectiveness studies have determined that the most sensitive echocardiographic modality should be selected as the initial and only test.
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Affiliation(s)
- William J Powers
- Department of Neurology, University of North Carolina School of Medicine, Chapel Hill, NC, United States.
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37
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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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38
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Farouji I, Chan KH, Abanoub R, Guron G, Slim J, Suleiman A. A rare case of co-occurrence of pulmonary embolism and left ventricular thrombus in a patient with COVID-19. SAGE Open Med Case Rep 2020; 8:2050313X20974534. [PMID: 33240504 PMCID: PMC7675891 DOI: 10.1177/2050313x20974534] [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: 08/22/2020] [Accepted: 10/28/2020] [Indexed: 01/08/2023] Open
Abstract
The global pandemic of severe acute respiratory syndrome coronavirus 2 has caused significant morbidity and mortality, not only causing devastating lung injury but also has an enormous effect on the cardiovascular system. The hypercoagulable state associated with coronavirus 2019 plays a major role in the disease manifestation. Venous thromboembolism including pulmonary embolism remains the most common thrombotic manifestation of the disease as compared to arterial thrombosis. Nonetheless, the co-occurrence of both venous and arterial thrombosis in a coronavirus 2019 patient, to our knowledge, has rarely been reported. Herein, we are presenting a case of co-occurrence of left ventricular thrombosis with pulmonary embolism in the setting of coronavirus 2019 with successful treatment with apixaban.
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Affiliation(s)
- Iyad Farouji
- Department of Medical Education,
Saint Michael’s Medical Centre, New York Medical College, Newark, NJ,
USA
| | - Kok Hoe Chan
- Department of Medical Education,
Saint Michael’s Medical Centre, New York Medical College, Newark, NJ,
USA
| | - Rushdy Abanoub
- Department of Cardiology, Saint
Joseph University Hospital, Paterson, NJ, USA
| | - Gunwant Guron
- Department of Medical Education,
Saint Michael’s Medical Centre, New York Medical College, Newark, NJ,
USA
- Department of Hematology/Oncology,
Saint Michael’s Medical Centre, New York Medical College, Newark, NJ,
USA
| | - Jihad Slim
- Department of Medical Education,
Saint Michael’s Medical Centre, New York Medical College, Newark, NJ,
USA
- Department of Infectious Disease,
Saint Michael’s Medical Centre, New York Medical College, Newark, NJ,
USA
| | - Addi Suleiman
- Department of Medical Education,
Saint Michael’s Medical Centre, New York Medical College, Newark, NJ,
USA
- Department of Cardiology, Saint
Michael’s Medical Centre, New York Medical College, Newark, NJ, USA
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39
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Sedhom R, Abdelmaseeh P, Megaly M, Asinger R. Use of Direct Oral Anticoagulants in the Treatment of Left Ventricular Thrombi: A Systematic Review. Am J Med 2020; 133:1266-1273.e6. [PMID: 32565258 DOI: 10.1016/j.amjmed.2020.05.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 05/13/2020] [Accepted: 05/14/2020] [Indexed: 12/16/2022]
Abstract
The off-label use of direct oral anticoagulants (DOACs) for the treatment of left ventricular thrombi has grown over the past several years given the ease of administration, absence of a requirement for international normalized ratio (INR) monitoring, and freedom from dietary restrictions; however, the evidence for their safety and efficacy is contradictory. We systematically searched PubMed and Google Scholar from January 1, 2009, to April 25, 2020, for studies of DOACs for treatment of left ventricular thrombi. Fifty-three articles (of 1,168 patients) met our inclusion criteria. We found that the studies have reached conflicting results; based on our findings, their routine use for the treatment of left ventricular thrombi cannot be recommended. Adequately powered randomized controlled trials are needed to determine the safest and most effective treatment for left ventricular thrombi.
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Affiliation(s)
- Ramy Sedhom
- Department of Medicine, Albert Einstein Medical Center, Philadelphia, Penn.
| | - Peter Abdelmaseeh
- Department of Medicine, Albert Einstein Medical Center, Philadelphia, Penn
| | - Michael Megaly
- Department of Cardiology, Hennepin Healthcare, Minneapolis, Minn; Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis
| | - Richard Asinger
- Department of Cardiology, Hennepin Healthcare, Minneapolis, Minn
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40
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Abstract
Biventricular thrombi are a rare clinical entity. Characterization of intracardiac masses using multiple advanced imaging modalities. Optimal treatment for biventricular thrombi remains unclear. Review management options for treating intraventricular thrombi.
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41
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Chrysohoou C, Magkas N, Antoniou CK, Manolakou P, Laina A, Tousoulis D. The Role of Antithrombotic Therapy in Heart Failure. Curr Pharm Des 2020; 26:2735-2761. [PMID: 32473621 DOI: 10.2174/1381612826666200531151823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 05/27/2020] [Indexed: 12/24/2022]
Abstract
Heart failure is a major contributor to global morbidity and mortality burden affecting approximately 1-2% of adults in developed countries, mounting to over 10% in individuals aged >70 years old. Heart failure is characterized by a prothrombotic state and increased rates of stroke and thromboembolism have been reported in heart failure patients compared with the general population. However, the impact of antithrombotic therapy on heart failure remains controversial. Administration of antiplatelet or anticoagulant therapy is the obvious (and well-established) choice in heart failure patients with cardiovascular comorbidity that necessitates their use, such as coronary artery disease or atrial fibrillation. In contrast, antithrombotic therapy has not demonstrated any clear benefit when administered for heart failure per se, i.e. with heart failure being the sole indication. Randomized studies have reported decreased stroke rates with warfarin use in patients with heart failure with reduced left ventricular ejection fraction, but at the expense of excessive bleeding. Non-vitamin K oral anticoagulants have shown a better safety profile in heart failure patients with atrial fibrillation compared with warfarin, however, current evidence about their role in heart failure with sinus rhythm is inconclusive and further research is needed. In the present review, we discuss the role of antithrombotic therapy in heart failure (beyond coronary artery disease), aiming to summarize evidence regarding the thrombotic risk and the role of antiplatelet and anticoagulant agents in patients with heart failure.
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Affiliation(s)
- Christina Chrysohoou
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
| | - Nikolaos Magkas
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
| | | | - Panagiota Manolakou
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
| | - Aggeliki Laina
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
| | - Dimitrios Tousoulis
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
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42
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L'Angiocola PD, Donati R. Cardiac Masses in Echocardiography: A Pragmatic Review. J Cardiovasc Echogr 2020; 30:5-14. [PMID: 32766100 PMCID: PMC7307625 DOI: 10.4103/jcecho.jcecho_2_20] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 02/18/2020] [Accepted: 02/25/2020] [Indexed: 01/07/2023] Open
Abstract
Transthoracic echocardiography is a useful diagnostic technique for the identification of intracardiac and extracardiac masses, which can evaluate morphologic properties of the masses such as their location, attachment, shape, size, mobility, and possible hemodynamic-related implications. Apart from physiological variants and structural normal mimickers, echocardiography can detect principal intracardiac masses such as neoplasms, thrombi, vegetation, and extracardiac masses such as metastatic lesions. Moreover, transesophageal echocardiography can provide further details and provide higher accuracy in case a deeper examination of the mass is needed. This review will focus on the systematic evaluation of intra-/extracardiac masses including epidemiology and morphological and echocardiographic features, providing practical and technical tips to health-care professionals to achieve correct identification of the masses. General data on cardiac masses were extracted via PubMed/MEDLINE search engine from indexed reviews, original studies, and clinical case reports. The echocardiographic features of cardiac masses were reviewed according to the most relevant international cardiology and echocardiography scientific societies' position statements.
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Affiliation(s)
| | - Roberto Donati
- Department of Cardiology, Giovan Battista Grassi Hospital, Rome, Italy
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43
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Yakabe D, Matsushima S, Uchino S, Ohtani K, Ide T, Higo T, Tsutsui H. Left Ventricular Noncompaction with Multiple Thrombi in Apical Aneurysm. Intern Med 2020; 59:377-381. [PMID: 31645531 PMCID: PMC7028405 DOI: 10.2169/internalmedicine.3489-19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 44-year-old man was admitted to our hospital due to heart failure. Transthoracic echocardiography demonstrated global hypokinesis with an ejection fraction of 25%, prominent trabeculation and deep intertrabecular recesses, and apical aneurysm with multiple thrombi (10×13 mm in the inferior wall, 15×8 mm in the anterior wall). Cardiac magnetic resonance imaging showed an increased ratio of noncompacted (NC) to compacted (C) myocardium (NC/C ratio >2.3) and apical aneurysm. Coronary angiography revealed no significant stenosis. He was therefore diagnosed with left ventricular noncompaction complicated by apical aneurysm. Four weeks after starting anticoagulation, the multiple apical thrombi disappeared without clinical signs of embolism.
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Affiliation(s)
- Daisuke Yakabe
- Department of Cardiovascular Medicine, Kyushu University Hospital, Japan
- Department of Cardiology and Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Japan
| | - Shouji Matsushima
- Department of Cardiovascular Medicine, Kyushu University Hospital, Japan
| | - Saori Uchino
- Department of Cardiovascular Medicine, Kyushu University Hospital, Japan
| | - Kisho Ohtani
- Department of Experimental and Clinical Cardiovascular Medicine, Kyushu University Faculty of Medicine Graduate School of Medical Sciences School of Medicine, Japan
| | - Tomomi Ide
- Department of Experimental and Clinical Cardiovascular Medicine, Kyushu University Faculty of Medicine Graduate School of Medical Sciences School of Medicine, Japan
| | - Taiki Higo
- Department of Cardiovascular Medicine, Kyushu University Faculty of Medicine Graduate School of Medical Sciences School of Medicine, Japan
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Kyushu University Faculty of Medicine Graduate School of Medical Sciences School of Medicine, Japan
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44
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Man With Pain in Both Legs. Ann Emerg Med 2019; 73:452-469. [DOI: 10.1016/j.annemergmed.2018.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Indexed: 11/20/2022]
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45
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Bolcal C, Kadan M, Kubat E, Erol G, Doğancı S. Surgical treatment of a left ventricular apical thrombus via robotic surgery. J Card Surg 2019; 34:216-218. [DOI: 10.1111/jocs.14000] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 02/05/2019] [Accepted: 02/06/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Cengiz Bolcal
- Department of Cardiovascular SurgeryHealth Sciences University Gülhane Training and Research HospitalAnkara Turkey
| | - Murat Kadan
- Department of Cardiovascular SurgeryHealth Sciences University Gülhane Training and Research HospitalAnkara Turkey
| | - Emre Kubat
- Department of Cardiovascular SurgeryHealth Sciences University Gülhane Training and Research HospitalAnkara Turkey
| | - Gökhan Erol
- Department of Cardiovascular SurgeryHealth Sciences University Gülhane Training and Research HospitalAnkara Turkey
| | - Suat Doğancı
- Department of Cardiovascular SurgeryHealth Sciences University Gülhane Training and Research HospitalAnkara Turkey
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46
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Moey MYY, Tomdio AN, Achike O, Kabirdas D. Large Left Ventricular Thrombus as a Cause of Recurrent Cardioembolic Stroke While on Dabigatran. ACTA ACUST UNITED AC 2018; 2:222-224. [PMID: 30370387 PMCID: PMC6200688 DOI: 10.1016/j.case.2018.04.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
LV thrombus can result in systemic embolization and ischemic stroke. Oral VKA therapy for ≥3 months is the recommended treatment of choice. The role of DOAC therapy in LV thrombus is limited to case reports. Surgical thrombectomy should be considered in patients with large mobile LV thrombi.
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Affiliation(s)
- Melissa Y Y Moey
- Department of Internal Medicine, Vidant Medical Center/East Carolina University, Greenville, North Carolina
| | - Anna N Tomdio
- Department of Internal Medicine, Vidant Medical Center/East Carolina University, Greenville, North Carolina
| | - Olisaemeka Achike
- Department of Cardiology, Vidant Medical Center/East Carolina University, Greenville, North Carolina
| | - Deepa Kabirdas
- Department of Cardiology, Vidant Medical Center/East Carolina University, Greenville, North Carolina
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47
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Ito S, Endo A, Okada T, Yoshitomi H, Hyakudomi R, Tajima Y, Tanabe K. A Case of Left Ventricular Thrombus with Superior Mesenteric Vein Thrombosis Due to Atopic Dermatitis. Int Heart J 2018; 59:881-886. [PMID: 29877306 DOI: 10.1536/ihj.17-386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A 55-year-old man was presented to the emergency room because of abdominal pain for 4 days. He had a history of atopic dermatitis. Left ventricular (LV) asynergy and thrombus was detected on echocardiography, and superior mesenteric vein thrombosis was detected by computed tomography. There are no reported cases of this combination of thrombi. We hypothesized that the reason for this complication is the combination of coagulation disorder due to atopic dermatitis, silent myocardial infarction, and exacerbation of the coagulation abnormality due to bacteremia, leading to superior mesenteric vein and LV thrombosis. Atopic dermatitis that has potential risk factors of thrombus with sepsis could provoke thrombophilic state. Atopic dermatitis is a common disease, but continuous medical care is essential.
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Affiliation(s)
- Shimpei Ito
- Division of Cardiology, Shimane University Faculty of Medicine
| | - Akihiro Endo
- Division of Cardiology, Shimane University Faculty of Medicine
| | - Taiji Okada
- Division of Cardiology, Shimane University Faculty of Medicine
| | | | - Ryoji Hyakudomi
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine
| | - Yoshitsugu Tajima
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine
| | - Kazuaki Tanabe
- Division of Cardiology, Shimane University Faculty of Medicine
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48
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Non-vitamin K antagonist oral anticoagulants for the treatment of intracardiac thrombosis. J Thromb Thrombolysis 2018; 46:332-338. [DOI: 10.1007/s11239-018-1693-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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49
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Urmeneta Ulloa J, Pérez Guerrero A, Molina Borao I, Fuentes Gorgas F, Miñano Oyarzabal A. Giant left ventricular thrombus embolism into the abdominal aorta. ACTA ACUST UNITED AC 2018; 65:414-416. [PMID: 29571728 DOI: 10.1016/j.redar.2018.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 02/03/2018] [Accepted: 02/05/2018] [Indexed: 11/30/2022]
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50
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Liao SF, Lee CH, Wu LS, Li CH, Chen HY. Left ventricular thrombus and systemic embolism after painless myocardial infarction in a young female. HONG KONG J EMERG ME 2018. [DOI: 10.1177/1024907917745233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Oral contraceptives are widely used because of their reliability. Although oral contraceptives are known to increase the risk of thromboembolic events, there are extremely few reports of oral contraceptive–induced left ventricular thrombus. Herein, we report a 37-year-old non-smoking female, who had regularly taken oral contraceptives for 14 years, developed an anterior myocardial infarction concomitant with left ventricular thrombus, bilateral segmental renal infarctions, and lower limb ischemia. Medical treatment with a combination of dual antiplatelet therapy and anticoagulants completely relieved her symptoms.
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Affiliation(s)
- Shao-Feng Liao
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan (R.O.C.)
| | - Ching-Hsing Lee
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan (R.O.C.)
- College of Medicine, Chang Gung University, Taoyuan, Taiwan (R.O.C.)
| | - Lung-Sheng Wu
- Cardiovascular Division, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan (R.O.C.)
| | - Chih-Huang Li
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan (R.O.C.)
- College of Medicine, Chang Gung University, Taoyuan, Taiwan (R.O.C.)
| | - Hsien-Yi Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan (R.O.C.)
- College of Medicine, Chang Gung University, Taoyuan, Taiwan (R.O.C.)
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