Effect Of Left Ventricular Thrombus Status On The Prognosis Of Patients With Heart Failure

Objective:In patients with heart failure（HF）combined with left ventricular thrombosis（LVT）under anticoagulation therapy,the impact of LVT status on the prognosis of these patients was investigated.Method:This study retrospectively collected 187 patients with HF combined with LVT who underwent transthoracic echocardiography（TTE）from January 2017 to June 2021 at the China-Japan Union Hospital of Jilin University and met the inclusion criteria and did not meet the exclusion criteria for anticoagulation.General patient data [gender,age,smoking,ischemic cardiomyopathy,new-onset heart failure,hypertension,diabetes mellitus,atrial fibrillation,BMI],serum biochemical parameters at admission [brain natriuretic peptide（NT-pro BNP）,glomerular filtration rate（GFR）,portal aminotransferase（AST）,hemoglobin（HGB）,white blood cells（WBC）,lymphocyte %（LYM%）,and mean platelet volume（MPV）,D-dimer,etc.].Ultrasound findings on admission [left ventricular ejection fraction（LVEF）,left ventricular end-diastolic dimension（LVEDD）,left ventricular thrombus area,ventricular wall tumor,etc.].Anticoagulation was given according to guideline norms,and the prognosis was observed.The primary outcome indicators were all-cause death,MACE（Major cardiovascular adverse events）（all-cause death,embolism,rehospitalization）,all embolic complications,rehospitalization rate,and bleeding.Secondary outcome indicators were LVT status,death,etc.under anticoagulation in HF patients with different etiologies;LVT status,embolism,bleeding,and death events in patients with different anticoagulation regimens.IBMSPSS statistical software 25.0 and Graph Pad Prism software 5 were used for statistical analysis.Results :Among 187 patients with HF combined with LVT on anticoagulation,a total of 64（34.2%）patients had persistent LVT and 123（65.8%）patients had disappeared LVT within 17.0 months（IQR: 6.0-24.0 months）.the proportion of patients with chronic HF was higher than that of patients with acute HF in the group with persistent LVT（62.5% vs.37.5%,P<0.05）;in terms of age,the LVT persistence group was higher than the LVT disappearance group（median: 66 vs 62.5,P<0.05）.After adjusting for confounders,the LVT persistence group had higher rates of all-cause death（HR=0.368,95% CI: 0.212-0.639,P<0.001）,MACE events（HR=0.607,95% CI: 0.394-0.934,P=0.023）,and all embolic complications（HR=0.226,95% CI: 0.075-0.934,P=0.023）compared with the LVT disappearance group.95% CI: 0.075-0.683,P=0.008)were significantly higher.There was no significant difference in bleeding and rehospitalization rates between the two groups（P=0.095,P=0.144）.The rate of disappearance of LVT and mortality was not statistically different in 160（85.6%）people with ischemic heart disease versus 27（14.4%）people with non-ischemic heart disease（P=0.916,P=0.661）,but the use of rivaroxaban was 97（61.4%）vs 12（41.4%）more in the ischemic heart disease group than in the non-ischemic heart disease group,（P=0.045）.There was no statistical difference between the various causes of heart failure due to ischemic heart disease（P=0.499）;nor was there a statistical difference between the various causes of heart failure due to nonischemic heart disease（P=0.132）.There were 109（58.3%）patients on rivaroxaban and 78（41.7%）patients on warfarin,and the LVT disappearance rate was 77（70.6%）vs.46（59%）in both groups,but the difference was not statistically significant by chi-square test（P=0.097）;the difference in bleeding events was not statistically significant by chisquare test 8（7.3%）vs.5（6.4%）（P= 0.805）;in terms of embolic events,a lower incidence of embolic events was observed with rivaroxaban than warfarin 5（4.6%）vs 10（12.8%）,（P=0.041）,with no statistically significant difference by chi-square test.Conclusion:1.Advanced age,chronic heart failure,lower glomerular filtration rate,and the presence of ventricular wall tumors were significantly associated with the persistence of LVT in patients with HF combined with LVT under anticoagulation therapy.2.Patients with persistent LVT had significantly higher rates of mortality,embolic incidence,and MACE events than patients with absent LVT.3.There was no significant difference in the rate of LVT disappearance between rivaroxaban and warfarin,and the incidence of systemic embolic events was lower in the rivaroxaban group.