Clinical characteristics and outcomes of left ventricular thrombus patients with mildly reduced and preserved left ventricular ejection fraction

Abstract Background Abnormal left ventricular ejection fraction (LVEF) is associated with the development of left ventricular thrombus (LVT) following acute myocardial infarction and also in non-ischaemic cardiomyopathies. LVT formation in normal LVEF is less common. Purpose We aimed to describe the clinical characteristics and outcomes of patients with LVT and LVEF>40%, and compare them against patients with LVT associated with LVEF≤40%. Methods We retrospectively studied 551 consecutive patients with LVT from our tertiary centre’s echocardiography database between March 2011 and January 2021. We compared baseline co-morbidities and echocardiographic parameters between patients with LVT and LVEF>40% versus LVEF≤40%. The Kaplan Meier method with log-rank test was used to compare rates of thrombus resolution, stroke and all-cause mortality between the 2 groups. Multivariable Cox regression models were constructed to correct for potential confounders. Results Mean age of the study population was 59.8 ± 12.9 years old and 86/551 (15.6%) were female. LVT in patients with LVEF>40% made up 100/551 cases (18.1%), of which 91.0% were associated with ischaemic heart disease. Patients with LVEF>40% were younger and had fewer cardiovascular co-morbidities than their counterparts with LVEF≤40%, including a lower prevalence of hypertension, hyperlipidaemia, diabetes mellitus, ischaemic heart disease and heart failure (Figure 1). Patients with LVEF>40% more often had a smaller thrombus (mean diameter 14.1 ± 5.9 mm) compared to those with LVEF≤40% (mean diameter 17.2 ± 8.2 mm). LVT with LVEF>40% was independently associated with thrombus resolution (HR 1.42, 95% CI 1.08–1.87, p=0.013) corrected for anticoagulant use, as well as lower mortality (HR 0.49, 95% CI 0.26–0.94, p=0.031) corrected for baseline co-morbidities (Figure 2). LVEF did not influence stroke rates. Conclusions In patients with LVEF>40%, LVT was less common. These patients had fewer cardiovascular co-morbidities, developed smaller thrombi, were more likely to have thrombus resolution and had a lower mortality rate. However, overall stroke risk was similar to patients with a reduced LVEF.Figure 1:Baseline characteristicsFigure 2:Outcomes