| 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 a single 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(MACCE;defined as the composite of cardiovascular death,ischemic stroke,and acute myocardial infarction).The median follow-up time was 3.8 years.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 MACCE 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 0.60,95%CI 0.32-1.13,P=0.11),cardiovascular death(HR 0.79,95%CI 0.41-1.50,P=0.5),and MACCE(HR 0.82,95%CI 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 unadjusted 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.BackgroundRecommendations for drug treatment of left ventricular thrombus(LVT)are based on the ST-segment elevation myocardial infarction(STEMI)guidelines;however,the etiology of LVT has changed.Due to lack of evidence regarding LVT treatment in the heart failure population,current heart failure guidelines do not cover LVT treatment.ObjectivesWe sought to review the etiology of LVT and changes in antithrombotic therapy over the previous 12 years and explore the impact of anticoagulation treatment.MethodsFrom January 2009 to June 2021,we studied 1675 patients with LVT by discharge diagnosis at a single center to investigate clinical characteristics,incidence of all-cause death,cardiovascular death,ischemic stroke,major adverse cardiac and cerebrovascular events(MACCE),systemic embolism(SE),and major bleeding.Patients were divided into an anticoagulant group and a non-anticoagulant group according to whether they received oral anticoagulant therapy at discharge.ResultsOverall,909 patients were included in the final analyses(anticoagulation,510;no anticoagulation,399).While overall antiplatelet therapy dramatically decreased,more patients with LVT started oral anticoagulation in 2021(29.6%)than in 2009(74.0%).Additionally,>50%of patients have left ventricular ejection fraction(LVEF)≤40%each year.All-cause mortality was 17.3%within a median follow-up period of 3.8 years(IQR:1.9-6.6 years).The incidences of cardiovascular death,stroke,MACCE,SE and major bleeding were 16.0%,3.3%,19.8%,5.1%,and 1.7%,respectively.The anticoagulation group had a significantly higher proportion of dilated cardiomyopathy than the nonanticoagulation group(24.7%vs.5.5%,P<0.001),and a lower LVEF(34.0 vs.41.0,p<0.001).Multivariable competing risk regression model suggested that there was no significant difference in all six endpoints between groups(all P>0.05).Similar results were found using propensity score-matched,and inverse probability of treatment weighting analysis.Diabetes mellitus(HR 1.43,95%CI 1.05-1.95,P=0.023),eGFR<60 ml/min/1.73m2(HR 2.22,95%CI 1.50-3.28,P<0.001),prior stroke(HR 1.48,95%CI 1.03-2.13,P=0.032),and LVEF≤40%(HR 2.43,95%CI 1.71-3.47,P<0.001)were independently associated with an increased risk of MACCE.ConclusionsHeart failure,rather than acute myocardial infarction,is currently the primary cause of LVT.Rivaroxaban has displaced warfarin as the most popular OAC for LVT patients.However,no improvement in prognosis was observed with anticoagulant therapy.Our study does not negate the efficacy of anticoagulation but suggests the need to strengthen the management of anticoagulation in order to achieve better efficacy.BackgroundThe focus of this investigation into the impact of type 2 diabetes mellitus(T2DM)on left ventricular thrombus(LVT)is(a)the differences in LVT characteristics,(b)long-term clinical outcomes,and(b)differential effects of direct oral anticoagulants(DOAC)among patients with T2DM and without diabetes.MethodsPatients with confirmed LVT from 2009 to 2021 were included.The primary endpoints were major adverse cardiac and cerebrovascular events(MACCE),composite of cardiovascular death,ischemic stroke,and acute myocardial infarction(AMI).The secondary endpoints were all-cause death and cardiovascular death.Multivariable competing risk regression and cumulative incidence function were used to evaluate the adverse consequences.ResultsIn total,1675 patients were assessed initially.Follow-up data were available for 91.1%of the participants.Median follow-up was 3.8 years.This retrospective study ultimately comprised 1068 participants,of which 429 had T2DM.Significantly higher proportions of comorbidities were observed in the T2DM group.The location,morphology,and size of LVT were similar in the two groups(P>0.05).Multivariable analysis suggested a higher risk of MACCE among patients with T2DM(HR 1.43,95%CI 1.06-1.92,P=0.018).The difference in risk between the two groups after matching and weighting was not statistically significant(P>0.05).Among the whole sample(n=638)or the just the nondiabetic patients with LVT and anticoagulation(n=382),the incidence of MACCE did not differ between DOAC treatment and warfarin treatment.In the diabetic LVT population with anticoagulation(n=256),DOAC treatment was associated with a significantly higher risk of MACCE than was warfarin treatment.ConclusionsThe location and morphology of LVT are similar in T2DM and non-diabetic patients.A higher risk of MACCE was found among patients with diabetes. |
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