The Correlation Between Left Ventricular Sphericity And Mural Thrombus In Patients With Dilated Cardiomyopathy

Background and ObjectiveIn recent years,continuous progress has been made in the diagnosis and treatment of dilated cardiomyopathy(dilated cardiomyopathy,DCM),but the mortality rate of DCM is still high.Patients with DCM have a higher risk of thromboembolism complications due to cardiac enlargement,weakening of ventricular wall pulsation,endocardial injury,abnormal hemorheology and blood hypercoagulable state.Thrombus shedding can lead to cerebral embolism,pulmonary embolism and peripheral arterial embolism,resulting in increased disability mortality.Studies have shown that patients with dilated cardiomyopathy have a higher incidence of intracardiac thrombosis(11%-44%)and clinical thromboembolic events(11%-20%),which is an important cause of death.Studies have shown that changes in ventricular morphology may play an important role in the formation of left ventricular mural thrombus.The normal shape of the left ventricle is the basis of blood swirl,which reduces the slow flow or even stagnation of blood in the left ventricle,and greatly reduces the probability of thrombosis;symmetrical ventricular structures(such as spherical shape)reduce the production of eddy current,promote blood stasis and increase the risk of thrombosis.At present,there are few studies on the changes of left ventricular morphology and mural thrombus in patients with DCM.Therefore,in this study,the degree of left ventricular spherical remodeling was calculated by cardiac magnetic resonance(cardiac magnetic resonance,CMR),and the degree of left ventricular spherical remodeling was quantitatively described.The purpose of this study is to explore the correlation between left ventricular spherical remodeling and mural thrombus in patients with DCM,in order to find early high-risk patients with mural thrombosis in dilated cardiomyopathy and timely intervention to reduce the occurrence of thromboembolism.MethodsPatients with dilated cardiomyopathy diagnosed in the Department of Cardiology of the first affiliated Hospital of Zhengzhou University from January 2015 to October 2019 were collected according to the formation of mural thrombus and matched by age and sex.A total of 56 pairs(112 cases)were included in the study group and the control group.The study group was patients with dilated cardiomyopathy with mural thrombus,and the control group was simple dilated cardiomyopathy without mural thrombus.Collect smoking history,drinking history,BMI,stroke,related medication history,blood routine(hemoglobin,platelet,erythrocyte distribution width,mean platelet volume),creatinine,uric acid,blood lipids(triglyceride,total cholesterol,low density lipoprotein cholesterol,high density lipoprotein cholesterol),N-terminal brain natriuretic peptide precursor and left ventricular transverse diameter measured by cardiac magnetic resonance.Left ventricular end-diastolic diameter,left ventricular end-diastolic volume,left ventricular end-systolic volume index,left ventricular end-diastolic volume index,myocardial mass index,left ventricular ejection fraction,The left ventricular sphericity was calculated according to the related indexes of cardiac magnetic resonance,and the statistical software SPSS22.0 was used to compare the difference of left ventricular sphericity and other related indexes between the two groups.Taking the formation of left ventricular mural thrombus as dependent variables,smoking history,drinking history,BMI,stroke,related medication history,blood routine,creatinine,uric acid,blood lipid,N-terminal brain natriuretic peptide precursor and cardiac magnetic resonance related indexes were used as independent variables for univariate conditional Logistic regression analysis.The selected risk factors were included in multivariate conditional Logistic regression analysis.The risk factors of left ventricular mural thrombosis in DCM were identified by analyzing these factors.Draw ROC curve to further analyze the value of left ventricular sphericity in the diagnosis of left ventricular mural thrombosis in DCM.The difference was statistically significant(P<0.05).Result1.The erythrocyte distribution width,average platelet volume and left ventricular sphericity in the study group were higher than those in the control group,while the left ventricular ejection fraction and left ventricular end-diastolic diameter in the study group were significantly lower than those in the control group(P<0.05).There was no significant difference in other indexes between the two groups(all P>0.05).Among,erythrocyte distribution width,mean platelet volume,left ventricular ejection fraction,left ventricular end-diastolic diameter and left ventricular sphericity in the study group and control group were respectively:erythrocyte distribution width[(12.58±1.05)%vs(12.09±1.43)%,P=0.048]?mean platelet volume[(11.671±1.09)fl vs(10.88±0.92)fl,P<0.001]?left ventricular ejection fraction[(19.13±7.14)%vs(22.54±19.13)%,P=0.005]?left ventricular end-diastolic long diameter[(94.10±8.22)mm vs(105.47±9.16)mm,P=0.045]?left ventricular sphericity[(68.26±16.44)%vs(48.80±9.63)%,P<0.001]?2.Univariate Logistic regression analysis showed that RDW[OR=1.407,95%CI(1.012,1.954),P=0.042]?MPV[OR=1.995,95%CI(1.313,3.031),P=0.001]?LVEF[OR=0.933,95%CI(0.877,0.993),P=0.030]and left ventricular sphericity[OR=1.195,95%CI(1.084,1.318),P<0.001]were risk factors,and the difference was statistically significant.There was no significant difference between other indexes and the formation of left ventricular mural thrombus(all P>0.05).3.The results of multivariate Logistic regression analysis showed that MPV[OR=1.907,95%CI(1.259,2.890),p=0.002]?LVEF[OR=0.918,95%CI(0.862,0.978),p=0.008]and left ventricular sphericity[OR=1.052,95%CI(1.017,1.088),p=0.004]were associated with left ventricular mural thrombosis,and they were all risk factors,and the difference was statistically significant.There was no significant difference between other indexes and the formation of left ventricular mural thrombus(all P>0.05).4.ROC curve analysis showed that the left ventricular sphericity[AUC=0.870,95%CI(0.806,0.934),P<0.001].According to the ROC curve and Jordan index analysis,when the left ventricular sphericity was 60.27%,the sensitivity and specificity were 69.6%and 89.3%,respectively.It has a certain diagnostic value for the formation of left ventricular mural thrombus in patients with dilated cardiomyopathy.Conclusion1.The left ventricular sphericity of patients with dilated cardiomyopathy with mural thrombus was higher than that of patients with simple dilated cardiomyopathy.2.Left ventricular sphericity is a risk factor for left ventricular mural thrombosis in patients with dilated cardiomyopathy and may be an independent predictor of mural thrombosis in patients with dilated cardiomyopathy.3.In this study,the spherical degree of left ventricle was used as the cut-off value of 60.27%to divide whether there was spherical left ventricle or not.it was found that patients with dilated cardiomyopathy with spherical left ventricle could easily lead to the formation of left ventricular mural thrombus.It is suggested that left ventricular sphericity is a quantitative index to evaluate left ventricular thrombosis in patients with dilated cardiomyopathy,which is helpful for early detection of mural thrombosis in patients with dilated cardiomyopathy and timely intervention to reduce the occurrence of thromboembolism.