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LEFT VENTRICULAR THROMBUS IN CARDIOMYOPATHY: CONTEMPORARY DETERMINANTS OF RESOLUTION, EVENTS AND SURVIVAL
Session:
Sessão de Posters 21 - Por dentro do miocárdio: da genética aos resultados
Speaker:
Luana Alves
Congress:
CPC 2026
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.2 Chronic Heart Failure – Epidemiology, Prognosis, Outcome
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Luana Alves; Joana Conde Gonçalves; Erivaldo Andrade; Tiago Prata Branco; Benedita Couto Viana; Sandra Amorim; Rui André Rodrigues
Abstract
<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong><span style="font-family:"Times New Roman",serif"><span style="color:#501549">Background:</span></span></strong><span style="font-family:"Times New Roman",serif"><span style="color:black"> Left ventricular thrombus (LVT) is a serious complication of ischemic and non-ischemic cardiomyopathies, carrying risks of embolic events, bleeding, and death. Predictors of thrombus resolution and their prognostic impact remain uncertain in contemporary practice.</span></span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong><span style="font-family:"Times New Roman",serif"><span style="color:#501549">Purpose:</span></span></strong><span style="font-family:"Times New Roman",serif"><span style="color:black"> To identify clinical, echocardiographic, and laboratory determinants of LVT resolution and assess their prognostic relevance for major cardiovascular events and mortality.</span></span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong><span style="font-family:"Times New Roman",serif"><span style="color:#501549">Methods: </span></span></strong><span style="font-family:"Times New Roman",serif"><span style="color:black">We analyzed 102 patients with echocardiographically confirmed LVT admitted to a tertiary care centre between January 2022 and December 2023. Thrombus resolution was defined as complete disappearance on follow-up imaging. Variables were grouped into clinical (age, sex, cardiomyopathy type, atrial fibrillation/flutter), laboratory (anemia = hemoglobin < 12 g/dL; thrombocytopenia = platelets < 100×10?/L; lipid profile; C-reactive protein; inflammatory indices</span></span><span style="font-family:"Times New Roman",serif"><span style="color:black">), and imaging (LVEF, LV aneurysm, wall-motion abnormalities, number, size and location of thrombi, and thrombus morphology - fresh vs calcified). The choice of anticoagulation (vitamin K antagonists or DOACs) was left to physician discretion. Primary endpoints were major bleeding, thromboembolism, major adverse cardiovascular events (MACE), and all-cause mortality. Logistic regression identified independent predictors; Kaplan–Meier analysis evaluated survival by thrombus resolution.</span></span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong><span style="font-family:"Times New Roman",serif"><span style="color:#501549">Results:</span></span></strong><span style="font-family:"Times New Roman",serif"><span style="color:black"> Median age was 65 (IQR 59–75) years, 84% were male and 70% had ischemic cardiomyopathy.</span></span> <span style="font-family:"Times New Roman",serif"><span style="color:black">Complete resolution occurred in 61 (59.8%) patients, with no significant difference between anticoagulant classes. Independent predictors of resolution were ischemic cardiomyopathy (OR 8.90, 95% CI 1.01–78.9; p = 0.049), fresh morphology (vs calcified: OR 0.15, 95% CI 0.03–0.81; p = 0.027), and higher HDL (OR 1.08; p = 0.012). During follow-up, thromboembolism occurred in 26.5%, major bleeding 4.9%, MACE 42.2%, and mortality 34.5%. Anaemia predicted thromboembolic events (OR 3.65, 95% CI 1.31–10.2; p = 0.014). Mortality was independently associated with thrombocytopenia (OR 13.8, 95% CI 1.76–108; p = 0.014) and age </span></span><span style="font-family:"Cambria Math",serif"><span style="color:black">≥</span></span><span style="font-family:"Times New Roman",serif"><span style="color:black"> 75 years (OR 5.92, 95% CI 1.86–18.8; p = 0.003). Thrombus resolution was protective for both MACE (OR 0.27, 95% CI 0.10</span></span><span style="font-family:"Cambria Math",serif"><span style="color:black">–</span></span><span style="font-family:"Times New Roman",serif"><span style="color:black">0.73; p = 0.014) and mortality (OR 0.16, 95% CI 0.05</span></span><span style="font-family:"Cambria Math",serif"><span style="color:black">–</span></span><span style="font-family:"Times New Roman",serif"><span style="color:black">0.53; p = 0.005). Kaplan</span></span><span style="font-family:"Cambria Math",serif"><span style="color:black">–</span></span><span style="font-family:"Times New Roman",serif"><span style="color:black">Meier curves confirmed improved survival with thrombus resolution (log-rank p < 0.01).</span></span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong><span style="font-family:"Times New Roman",serif"><span style="color:#501549">Conclusions:</span></span></strong><span style="font-family:"Times New Roman",serif"><span style="color:black"> High HDL, ischemic substrate, and fresh morphology independently predict LVT resolution. Anaemia marks excess thromboembolic risk, while advanced age and thrombocytopenia predict death. Thrombus resolution confers marked protection against MACE and mortality. These findings highlight the interplay between myocardial substrate, thrombus biology, and systemic risk, supporting an integrated, individualized strategy to improve LVT outcomes.</span></span></span></span></span></p>
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