Author + information
- Received June 28, 2019
- Revision received January 28, 2020
- Accepted January 30, 2020
- Published online April 6, 2020.
- Benoit Lattuca, MDa,∗,
- Nesrine Bouziri, MDa,∗,
- Mathieu Kerneis, MDa,
- Jean-Jacques Portal, PhDb,
- Jiannong Zhou, BScc,
- Marie Hauguel-Moreau, MDa,
- Amel Mameri, MDa,
- Michel Zeitouni, MDa,
- Paul Guedeney, MDa,
- Nadjib Hammoudi, MD, PhDa,
- Richard Isnard, MD, PhDa,
- Françoise Pousset, MDa,
- Jean-Philippe Collet, MD, PhDa,
- Eric Vicaut, MD, PhDb,
- Gilles Montalescot, MD, PhDa,∗ (, )@ActionCoeur,
- Johanne Silvain, MD, PhDa@docjohanne,
- for the ACTION Study Group
- aSorbonne Université, ACTION Study Group, INSERM UMR_S 1166, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France
- bUnité de Recherche Clinique, Lariboisière Hospital (AP-HP), ACTION Study Group, Paris, France
- cInformation system department, Pitié-Salpêtrière Hospital (AP-HP), Paris, France
- ↵∗Address for correspondence:
Dr. Gilles Montalescot, ACTION Study Group, Institut de Cardiologie, Centre Hospitalier Universitaire Pitié-Salpêtrière, 47 Boulevard de l’Hôpital, 75013 Paris, France.
Background Contemporary data are lacking regarding the prognosis and management of left ventricular thrombus (LVT).
Objectives The purpose of this study was to quantify the effect of anticoagulation therapy on LVT evolution using sequential imaging and to determine the impact of LVT regression on the incidence of thromboembolism, bleeding, and mortality.
Methods From January 2011 to January 2018, a comprehensive computerized search of LVT was conducted using 90,065 consecutive echocardiogram reports. Only patients with a confirmed LVT were included after imaging review by 2 independent experts. Major adverse cardiovascular events (MACE), which included death, stroke, myocardial infarction, or acute peripheral artery emboli, were determined as well as major bleeding events (BARC ≥3) and all-cause mortality rates.
Results There were 159 patients with a confirmed LVT. Patients were treated with vitamin K antagonists (48.4%), parenteral heparins (27.7%), and direct oral anticoagulants (22.6%). Antiplatelet therapy was used in 67.9% of the population. A reduction of the LVT area from baseline was observed in 121 patients (76.1%), and total LVT regression occurred in 99 patients (62.3%) within a median time of 103 days (interquartile range: 32 to 392 days). The independent correlates of LVT regression were a nonischemic cardiomyopathy (hazard ratio [HR]: 2.74; 95% confidence interval [CI]: 1.43 to 5.26; p = 0.002) and a smaller baseline thrombus area (HR: 0.66; 95% CI: 0.45 to 0.96; p = 0.031). The frequency of MACE was 37.1%; mortality 18.9%; stroke 13.3%; and major bleeding 13.2% during a median follow-up of 632 days (interquartile range: 187 to 1,126 days). MACE occurred in 35.4% and 40.0% of patients with total LVT regression and those with persistent LVT (p = 0.203). A reduced risk of mortality was observed among patients with total LVT regression (HR: 0.48; 95% CI: 0.23 to 0.98; p = 0.039), whereas an increased major bleeding risk was observed among patients with persistent LVT (9.1% vs. 12%; HR 0.34; 95% CI: 0.14 to 0.82; p = 0.011). A left ventricular ejection fraction ≥35% (HR: 0.46; 95% CI: 0.23 to 0.93; p = 0.029) and anticoagulation therapy >3 months (HR: 0.42; 95% CI: 0.20 to 0.88; p = 0.021) were independently associated with less MACE.
Conclusions The presence of LVT was associated with a very high risk of MACE and mortality. Total LVT regression, obtained with different anticoagulant regimens, was associated with reduced mortality.
- direct oral anticoagulant
- left ventricular thrombus
- myocardial infarction
- thrombus regression
↵∗ Drs. Lattuca and Bouziri contributed equally to this work.
This work was supported by Allies in Cardiovascular Trials Initiatives and Organized Networks ACTION Group. Dr. Lattuca has received research grants from Biotronik, Boston Scientific, Daiichi-Sankyo, Fédération Française de Cardiologie, and Institute of CardioMetabolism and Nutrition; has received consultant fees from Daiichi-Sankyo and Eli Lilly; and has received lecture fees from AstraZeneca and Novartis. Dr. Kerneis has received research grants from Fédération Française de Cardiologie, European Society of Cardiology, and Servier; and has received consultant fees from AstraZeneca, Bayer, Daiichi-Sankyo, Eli Lilly, and Sanofi. Dr. Zeitouni has received research grants from Fédération Française de Cardiologie and Servier. Dr. Hammoudi has received research grants to the institution or consulting/lecture fees from Philips, Bayer, Laboratoires Servier, Novartis Pharma, AstraZeneca, Bristol-Myers Squibb, Merck Sharp & Dohme, Fédération Française de Cardiologie, and ICAN. Dr. Isnard has served on the Advisory Board of and led lectures for Novartis, Servier, and Bayer; and has led lectures for Amgen and Pfizer. Dr. Collet has received research grants from AstraZeneca, Bayer, Bristol-Myers Squibb, Boston Scientific, Daiichi-Sankyo, Eli Lilly, Fédération Française de Cardiologie, Lead-Up, Medtronic, Merck Sharp & Dohme, Sanofi, and WebMD. Dr. Vicaut has received research grants from Boehringer and Sanofi; and has received consultant fees from Abbott, Eli Lilly, Hexacath, Fresenius, LFB, Medtronic, Novartis, Pfizer, and Sanofi. Dr. Montalescot has received research grants from Abbott, Amgen, Actelion, American College of Cardiology Foundation, AstraZeneca, Axis-Santé, Bayer, Boston Scientific, Boehringer Ingelheim, Bristol-Myers Squibb, Beth Israel Deaconess Medical, Brigham Women’s Hospital, China Heart House, Daiichi-Sankyo, Idorsia, Elsevier, Europa, Fédération Française de Cardiologie, ICAN, Lead-Up, Medtronic, Menarini, Merck Sharp & Dohme, NovoNordisk, Partners, Pfizer, Quantum Genomics, Sanofi, Servier, and WebMD. Dr. Silvain has received research grants from Algorythm and Fondation de France; and has received lecture fees from Amed, Amgen, AstraZeneca, Bayer, CSL Behring, Daiichi-Sankyo, Eli Lilly, Gilead Science, Iroko Cardio, Sanofi, and St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Michael D. Ezekowitz MBChB, DPhil, served as Guest Associate Editor for this paper.
- Received June 28, 2019.
- Revision received January 28, 2020.
- Accepted January 30, 2020.
- 2020 American College of Cardiology Foundation
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