Left ventricular thrombus and the incidence of thromboembolism in patients with congestive heart failure: can clinical factors identify patients at increased risk?

Abstract Objective: To determine the predictive value of CHA2DS2–VASc score as a predictor for left ventricular thrombus after acute anterior ST-elevation myocardial infarction (STEMI).Methods: We performed a case–control retrospective study of 30 patients with left ventricular thrombus (median age: 60.6 years, range: 38–75 years old; 26 males, 74 females) and 60 age- and sex-matched controls without left ventricular thrombus. Correlation analysis was performed and receiver operating characteristic (ROC) curve was used to evaluate the predictive value of CHA2DS2–VASc score in detecting left ventricular thrombus.Result: Patients with left ventricular thrombus after acute anterior STEMI had higher CHA2DS2–VASc scores than controls (P < 0.001). Correlation analysis revealed that CHA2DS2–VASc scores were positively correlated with left ventricular thrombus after acute anterior STEMI (r = 0.413; P < 0.001). Multiple logistic regression analyses indicated that CHA2DS2–VASc scores (P = 0.001) and heart failure (P = 0.023) were risk factors of left ventricular thrombus. The ROC curve of CHA2DS2–VASc scores revealed that area under curve was 0.746 (95% confidence interval: 0.638–0.853, P < 0.001), sensibility was 86.7%, and specificity was 50.0%.Conclusion: Patients with heart failure have a high incidence of left ventricular thrombus after acute anterior STEMI. CHA2DS2–VASc scores contribute to the prediction for left ventricular thrombus after acute anterior STEMI.

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Arterial thromboembolism in a young woman with occult dilated cardiomyopathy

Case Reports in Internal Medicine ◽

10.5430/crim.v3n3p12 ◽

2016 ◽

Vol 3 (3) ◽

pp. 12

Author(s):

Alicia Topoll ◽

Jordan Owens ◽

Jorge Cheirif ◽

J. Mark Pool ◽

Mark Feldman

Keyword(s):

Heart Failure ◽

Dilated Cardiomyopathy ◽

Systolic Heart Failure ◽

Left Ventricular ◽

Left Ventricular Thrombus ◽

Caucasian Woman ◽

Prothrombotic State ◽

Vascular Intervention ◽

Arterial Thromboembolism ◽

Ventricular Thrombus

An acute dilated cardiomyopathy may present with vague symptoms including fatigue and malaise, which may delay the diagnosis until signs and symptoms of systolic heart failure develop. Left ventricular thrombus and arterial thromboembolism are rare complications of acute dilated cardiomyopathy. We present a case of a young Caucasian woman presenting with acute leg ischemia secondary to femoral artery thromboembolism associated with a previously undiagnosed acute dilated cardiomyopathy with severe systolic heart failure and a large left ventricular thrombus. Her prothrombotic state was refractory to heparin therapy and surgical vascular intervention. She eventually required leg amputation for recurrent limb ischemia with gangrene and thrombus extraction from the left ventricle. Risk factors for her prothrombotic state included the acute, dilated cardiomyopathy, use of a hormonal contraceptive agent, obesity, smoking, and a heterozygous Factor II (Prothrombin) G20110A mutation.

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