Risk factors for intracardiac thrombus in peripartum cardiomyopathy: a retrospective study in China

Abstract

Aims Peripartum cardiomyopathy (PPCM) are more vulnerable to intracardiac thrombus than other types of cardiomyopathies, although explicit anticoagulant strategy is not sure. Too aggressive anticoagulation therapy can lead to severe bleeding events. Hence, we want to construct a risk stratification model for intracardiac thrombus in PPCM patients. Methods and results A total of 159 suspected PPCM cases were initially screened, whereas 123 confirmed cases were enrolled in the final analysis. The study population was randomly assigned as derivation group ( N = 83) and validation group ( N = 40). The derivation cohort was utilized to develop the model, and the validation cohort was used to internal validate the discriminatory ability of the model. Formation of intracardiac thrombus was detected in 22 patients. After adjusted by multivariable logistic regression analysis, left ventricle ejection fraction (LVEF, OR 0.772, 95% CI 0.665–0.897, P = 0.001), haemoglobin levels (OR 1.050, 95% CI 1.003–1.099, P = 0.038), and thrombocyte counts (OR 1.018, 95% CI 1.006–1.029, P = 0.003) were identified as risk factors independently associated with intracardiac thrombus and were finally included in the tentative risk stratification model with a C‐indexes of 0.916 (95% CI: 0.850–0.982, P < 0.001). A score of ≤7 was regarded as low risk, 8–10 defined intermediate risk, and ≥11 defined high risk in our model. Internal validation showed good discriminatory ability of the model with a C‐indexes of 0.790 (95% CI: 0.644–0.936, P = 0.017). Conclusions In our retrospective study, impaired LVEF, elevated haemoglobin levels, and high thrombocyte counts were regarded as independent risk factors for intracardiac thrombus in PPCM. A risk stratification model derived from these risk factors, which was economic and easily applicable in clinical practice, could rapidly and accurately identify PPCM patients with higher‐risk of intracardiac thrombus.

A Rare Case of Peripartum Cardiomyopathy Followed Up for Intracardiac Thrombus and Sudden Embolism of Right Coronary Artery: A Case Report and Review of the Literature

“…Dilated cardiomyopathies are the most important risk factor for intracardiac thrombus due to intracavitary stasis of blood, and the risk of intracardiac thrombus in PPCM is higher than in other types of cardiomyopathy. 12 The main reason for this is thought to be the increased tendency of the peripartum period to hypercoagulation. In order to maintain the normal function of the utero-placental unit and to minimize the risk of bleeding during childbirth, a large number of clotting factors (including factors VIII, X, and XII) and fibrinogen are increased in the blood.…”

Avaliação da terapia anticoagulante na cardiomiopatia dilatada puerperal: uma revisão de escopo

“…As evidências científicas ainda apontam que na maioria dos casos observados, pacientes com disfunção cardiovascular dilatada periparto apresentam sinais e sintomas como qualquer outra insuficiência cardíaca sistólica (Fu, et al, 2022). Assim como (Jackson, et al, 2018) e (Chaudhari, et al, 2022), Fu e colaboradores também demonstraram que a cardiomiopatia dilatada periparto se expressa através de sinais como a dispneia, a fadiga, o edema de membros inferiores e a congestão hepática.…”

“…Diferentemente de outras etiologias de CMD, a CMPP tem sido associada a uma maior incidência de trombos intracardíacos (Kido & Guglin., 2019). Em um estudo retrospectivo realizado na China, dentre 123 casos analisados para CMPP, a formação de trombo intracardíaco foi detectada em 22 pacientes, de modo que a FEVE reduzida, assim como os níveis elevados de hemoglobina e de agentes trombóticos foram considerados fatores de risco independentes que contribuindo para a piora do prognóstico (Fu, et al, 2022).…”

“…Ainda que não hajam achados característicos da CMPP na ressonância magnética cardíaca, esse exame de imagem se revela como um método complementar ao ecocardiograma, fornecendo uma maior sensibilidade para a detecção de trombos intracardíacos, além de ser considerado mais seguro na gestação, devido a ausência de radiação ionizante (Fu et al, 2022). Os estudos de Chaudhari e colaboradores, comparativamente, também indicam que a ressonância magnética cardíaca pode ser útil para o reconhecimento de áreas cardíacas que foram alvo de fibrose, necrose, hiperemia ou lesão intersticial.…”

“…Existem países em que a incidência de CMPP é significativamente maior. Na Nigéria e no Haiti, por exemplo, regiões com maior predomínio de afrodescendentes, estima-se que a prevalência de cardiomiopatia puerperal seja de 1 a cada 100 ou 300 gestações (Fu et al, 2022). Entretanto, as evidências apontam que na Austalásia e no Brasil os indicadores estatísticos relacionados a essa doença ainda não são precisos (Jackson et al, 2018).…”