Clinical characteristics of patients with heart failure and intracardiac thrombus

Mei Zhai; Liyan Huang; Lin Liang; Pengchao Tian; Lang Zhao; Xuemei Zhao; Boping Huang; Jiayu Feng; Yan Huang; Qiong Zhou; Yuhui Zhang; Jian Zhang

doi:10.3389/fcvm.2022.934160

Clinical characteristics of patients with heart failure and intracardiac thrombus

Front Cardiovasc Med. 2022 Oct 6:9:934160. doi: 10.3389/fcvm.2022.934160. eCollection 2022.

Authors

Mei Zhai¹, Liyan Huang¹, Lin Liang¹, Pengchao Tian¹, Lang Zhao¹, Xuemei Zhao¹, Boping Huang¹, Jiayu Feng¹, Yan Huang¹, Qiong Zhou¹, Yuhui Zhang¹, Jian Zhang¹

Affiliation

¹ State Key Laboratory of Cardiovascular Disease, Heart Failure Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC), Beijing, China.

Abstract

Background: Heart failure (HF) patients are in a hypercoagulable state that predisposes them to an intracardiac thrombus. We aim to assess the clinical features of patients with HF and intracardiac thrombus.

Methods: Patients diagnosed with HF with intracardiac thrombus were enrolled in this study. Patients' demographics, clinical comorbidities, laboratory tests, and cardiac imaging parameters are recorded. Baseline characteristics are described; the relationship between intracardiac thrombus location and cardiac underlying diseases, New York Heart Association (NYHA) class, and left ventricular ejection fraction (LVEF) are analyzed; and the anticoagulation rate is summarized.

Results: A total of 1,248 patients were included in the study. Most patients were men (72.2%) with a mean age of 54 years. The left ventricle is the most frequently involved (66.8%), and the prevalence of left ventricular thrombus is more in patients complicated with coronary artery diseases, ventricular noncompaction cardiomyopathy, and dilated cardiomyopathy (86.3%, 86.4%, and 78.2%, respectively). When combined with atrial fibrillation, atrial flutter, hypertrophic cardiomyopathy, restrictive cardiomyopathy, or valvular cardiomyopathy, the intracardiac thrombus is mostly likely to occur in the left atrium. The incidence rate of left cardiac thrombosis increased with the decline of LVEF, an increase of NYHA class, and enlargement of a cardiac chamber. Overall, the anticoagulation rate was 56.8%, with warfarin still the mainstay drug (45.1%), while the prescription of non-vitamin K antagonist oral anticoagulants rose year by year. As for imaging modalities for thrombus detection and diagnosis, transthoracic echocardiography was the most widely performed (75.1%).

Conclusion: This study summarizes the underlying disease constitution, thrombus location and related factors, imaging modalities, and antithrombotic profile in HF patients with intracardiac thrombus comprehensively.

Keywords: anticoagulants; cardiomyopathy; heart failure; intracardiac thrombus; left ventricular dysfunction.