Left Ventricular Thrombus

McCarthy, Cian P.; Murphy, Sean; Venkateswaran, Ramkumar V.; Singh, Avinainder; Chang, Leslie; Joice, Melvin G.; Rivero, Jose; Vaduganathan, Muthiah; Januzzi, James L.; Bhatt, Deepak L.

doi:10.1016/j.jacc.2019.01.031

Cited by 78 publications

(16 citation statements)

References 2 publications

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“…Standard transthoracic echocardiography (TTE) is typically the screening modality of choice for LV thrombus detection and should be performed within 24 hours of admission in those at high risk for apical LV thrombus [2,3]. Our patient had subtle symptoms of arm heaviness that he neglected and did not seek medical care of it.…”

Section: Discussionmentioning

confidence: 95%

ST-Elevation Myocardial Infarction Presenting as Acute Limb Ischemia

Ahmed

Haque

2020

Cureus

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We describe a case of delayed presentation of ST-segment elevation myocardial infarction (STEMI) complicated by ventricular thrombus and peripheral embolization causing limb ischemia. Our patient initially presented with symptoms of acute limb ischemia. However, on preoperative evaluation, STEMI was diagnosed. He required emergent revascularization of the left anterior descending artery followed by thrombectomy of the femoral artery. The cause of the limb ischemia was deemed to be a late presenting STEMI that was complicated by left ventricular thrombus, hence causing lower extremity embolization. Delayed presentations and complications related to STEMI may manifest as acute limb ischemia in the setting of ventricular thrombus formation and subsequent distal embolization.

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Section: Discussionmentioning

confidence: 95%

ST-Elevation Myocardial Infarction Presenting as Acute Limb Ischemia

Ahmed

Haque

2020

Cureus

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“…A previous retrospective review of more than 80,000 medical records revealed that the incidence of LVT is 7 per 10,000 patients ( 16 ). Another observational study identified 128 patients with LV thrombus from 140,636 echocardiograms ( 4 ). Consistent with these reports, the incidence of LVT was also low in our study and only 156 patients were recruited after screening more than 957,000 echocardiographic records.…”

Section: Discussionmentioning

confidence: 99%

“…The etiology of LVT patients evolves. One study showed that 80% of LVT cases are ischemic ( 16 ), and McCarthy et al showed that de novo HF (38%) was more frequently associated with LVT compared to acute MI (25.9%) ( 4 ). This discrepancy may be due to the bias of small LVT population, or the different criteria utilized by the studies to analyze the precipitating factor of LVT.…”

Section: Discussionmentioning

confidence: 99%

“…Both ischemic and non-ischemic LVT formation follow the Virchow's triad including reduced ventricular wall motion, endomyocardial injury and hypercoagulability/stasis of blood flow ( 1 , 2 ). Despite primary percutaneous coronary intervention (PCI) and the significant scientific breakthrough beyond foundational neurohormonal therapies improving the prognosis of heart failure (HF) in recent decades, patients with LVT are at a higher risk of cardioembolic stroke, systemic embolization and all cause death ( 3 ), and the cumulative incidence of thromboembolism and mortality is as high as 20% ( 4 ). Nevertheless, little is known regarding risk stratification in LVT, which warrants identification of novel prognostic biomarkers.…”

Section: Introductionmentioning

confidence: 99%

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Prognostic Significance of B-Type Natriuretic Peptide in Patients With Left Ventricular Thrombus

Gao

Wang

et al. 2021

Front. Cardiovasc. Med.

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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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“…Heart failure is the most common cause of LV thrombus. Presence of a dyskinetic segment and LVEF <40% are important risk factors [1,2]. Most thrombi resolve by undergoing spontaneous lysis, a process which is facilitated by anticoagulation.…”

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confidence: 99%