Analyze The Independent Risk Factors Of Adult With Heart Failure Patients And Thrombosis In Left Ventricle

Objective To explore the independent risk factors of left ventricular thrombosis in patients with heart failure(HF)and to provide a theoretical basis for early prevention and detection of left ventricular thrombus(LVT)and then to prevent and treat its' complications.Methods A total of 82 patients diagnosed with HF and LVT were enrolled from the First Affiliated Hospital of Guangxi Medical University between the first month of 2012 and the last month of 2017 call as LVT group.Contemporaneously,184 pure HF patients were randomly selected call as Non-LVT group.All the corresponding clinical data were collected.Two-classification Logistic regression model of HF and LVT was established to identify the independent risk factors,the categorical variables with significant differences in regression were analyzed by subgroup analysis,and the receiver operating characteristic curve(ROC)-Jordan index was further analyzed by continuous variables.Results The general clinical data showed that the differences of age,systolic pressure,heart rate,hemoglobin,platelet count,creatinine,uric acid,alanine aminotransferase,homocysteine,dilated cardiomyopathy and myocardial infarction showed significant difference in group LVT(P < 0.05).Echocardiography in the heart were performed and the parameters indicated marked differences in left ventricular diastolic diameter,left ventricular diastolic diameter,left ventricular posterior wall thickness,Left ventricular ejection fraction,left ventricular mass index and ventricular aneurysm in LVT group(P < 0.05).BNP showed P < 0.001 via the testing method of Mann-Whitney U,then the results showed that the median of the LVT group(5437.00pg/ml)was significantly higher than that of the Non-LVT group(2346.00pg/ml).The binary logistic regression analysis showed that the increases of heart rate(OR = 1.025,95% CI: 1.007-1.043),the decrease of left ventricular ejection fraction(LVEF)(OR = 0.933,95% CI: 0.908-0.958),the myocardial infarction(OR= 4.557,95% CI: 2.022-10.271)and the left ventricular aneurysm(LVA)(OR = 33.531,95% CI: 3.489-322.240)were all perceived as contributing to the independent risk factors of patients with HF and LVT.According to the group of myocardial infarction and LVA,they were analyzed by multivariate Logistic regression.In the subgroup of myocardial infarction,the heart rate(OR=1.026,95% Cl: 1.006-1.045),the LVEF(OR=0.927,95% CI: 0.902-0.954),and LVA(OR=15.598,95% CI: 1.136-214.195)of the subgroup without myocardial infarction were components of the risk attributable to the formation of LVT in HF patients.Among the patients with simultaneous myocardial infarction,only the decrease of LVEF was an independent risk factor for HF with LVT.In the subgroup analysis of LVA,the admission heart rate(OR=1.023,95% CI: 1.006-1.041),LVEF(OR=0.925,95% CI: 0.902-0.949,and myocardial infarction(OR=3.655,95% CI: 1.634-8.177)of the subgroup without LVA were the risk factors for the formation of LVT in HF patients.But when simultaneously combined with LVA,the binary logistic regression was performed and the results showed that there was no independent variable of P < 0.05.The heart rate and LVEF of experimental group were analyzed by ROC curve and the result revealed that the area of the admission heart rate and LVEF were 0.661 and 0.760 respectively and both P values were under 0.01.The analysis of Youden index showed that the critical value of the heart rate was 94 beats per minute,the sensitivity was 50.0% and the specificity was 79.9%.The critical value of LVEF was 44.0%,the sensitivity was 70.7% and the specificity was 75.6%.Conclusion HF combined with LVT is affected by a variety of factors.This study showed that the increase of heart rate,the decline LVEF,myocardial infarction and LVA were independent risk factors for LVT in HF patients.Among the patients who suffered from both HF and myocardial infarction,the decline of LVEF was an independent risk factor for HF combined with LVT.Patients with HF are suggested that their heart rate should be controlled below 94 beats per minute,and LVEF should be increased to more than 44% to reduce the risk of left ventricular thrombosis.Clinically,patients with high risk of HF and LVT should be found early and actively intervene in controllable factors to avoid thromboembolic events.