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Previous studies have not evaluated the prevalence and the presence of specific risk factors for the development of left ventricular thrombus (LVT) among chemotherapy related cardiomyopathy (CRC) patients who develop severe left ventricular (LV) systolic dysfunction. We used echocardiographic and clinical data to evaluate prevalence and potential markers of LVT in this population.
From October 2008 to September 2011, all patients with severe LV systolic dysfunction (LV ejection fraction ≤ 30%) were selected from MD Anderson Cancer Center echocardiographic database. Patients with CRC as the etiology of LV systolic dysfunction were identified from medical records and included in the study. LVT was identified by echocardiogram. Patient characteristics and echocardiographic parameters were analyzed to determine potential risk factors for LVT.
A total of 446 patients with severe LV dysfunction were indentified. After medical record review, 83 patients (18.6%) with CRC were included in the study. Anthracycline (72 patients, 86.7%) is the major chemotherapeutic agent related to LV systolic dysfunction. LVT was found in 8 patients (9.6%). The patient characteristics, including echo contrast use, were not significantly different among patients with or without LVT. Breast cancer (27 patient, 32.5%) and lymphoma (26 patients, 31.3%) were among the most common cancers. The patients with LVT have significantly lower LV systolic function (mean ± SD: 18.7 ± 4.8% VS 25.6 ± 4.7%, p < 0.01). There are two echocardiographic parameters that are statistically significant in association with LVT formation: LV ejection fraction < 20% (odds ratio 17.5; 95% confidence interval 3.1 to 97.8; p < 0.01) and a restrictive LV filling pattern (odds ratio 6.3; 95% confidence interval 1.2 to 32.2; p 0.03).
Among CRC patients with severe LV systolic dysfunction, LVT was found in 9.6% of subjects. A LV ejection fraction < 20% and restrictive LV filling pattern were significantly associated with the finding of left LVT. The presence of these findings in CRC patients with severe LV systolic dysfunction should raise our index of suspicion and promote a careful echocardiographic search for LVT.
Poster Sessions, Expo North
Saturday, March 09, 2013, 10:00 a.m.-10:45 a.m.
Session Title: Dilated Cardiomyopathies: From Peripartum, Cancer Therapy, Familial Cardiomyopathies to Cardiac Amyloidosis
Abstract Category: 15. Heart Failure: Clinical
Presentation Number: 1134-288
- 2013 American College of Cardiology Foundation